Active NPI
Kellie Bonner Bedoni, MS PT
- Physical Therapist
- Everett, MA
National Provider Identifier
1891806501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13001
- Practice address
- 602 Broadway
Everett, MA 02149 - Phone
- (671) 389-7211
- Fax
- (617) 389-7225
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 13001 | MA | Primary |
Addresses
Primary practice location
602 Broadway
Everett, MA 02149
Mailing address
405 Pearl Street
North Suburban Orthopedic Associates Inc
Malden, MA 02148
Phone (781) 321-8785
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 612930 | Other | TUFTS GROUP | |
| 613542 | Other | HARVARD PILGRIM GROUP | |
| Y67652 | Other | BCBS INDIVIDUAL | |
| 0000Y61011 | Other | BCBS GROUP |
Other names 1
- Miss Kellie Marie Bonner
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459814400000",
"number": "1891806501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 PEARL STREET",
"address_2": "NORTH SUBURBAN ORTHOPEDIC ASSOCIATES INC",
"city": "MALDEN",
"state": "MA",
"postal_code": "02148",
"telephone_number": "781-321-8785",
"fax_number": "781-321-8063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 BROADWAY",
"city": "EVERETT",
"state": "MA",
"postal_code": "02149",
"telephone_number": "671-389-7211",
"fax_number": "617-389-7225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEDONI",
"first_name": "KELLIE",
"middle_name": "BONNER",
"name_prefix": "Mrs.",
"credential": "MS PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2016-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "13001",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS GROUP",
"identifier": "612930",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM GROUP",
"identifier": "613542",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDIVIDUAL",
"identifier": "Y67652",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP",
"identifier": "0000Y61011",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLIE",
"last_name": "BONNER",
"middle_name": "MARIE",
"prefix": "MISS",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Everett, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.