1437240066 NPI number — TIMOTHY I BONDY INC

Table of content: (NPI 1437240066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437240066 NPI number — TIMOTHY I BONDY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY I BONDY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TIM BONDY PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437240066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
339 SUNSET RD
Provider Second Line Business Mailing Address:
PO BOX 487
Provider Business Mailing Address City Name:
PETOSKEY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-347-3074
Provider Business Mailing Address Fax Number:
231-347-2886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1171 W CONWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARBOR SPRINGS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-487-6163
Provider Business Practice Location Address Fax Number:
231-347-0567
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BONDY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
IVAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
231-347-3074

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  5501001455 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P30665 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 30665 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4773166 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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