Organization
BONNER PHYSICAL THERAPY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN A SODORFF (PT)
(208) 263-5731
Entity
Organization
Contact information
Practice address
1327 SUPERIOR ST, SANDPOINT, ID 83864-1735
(208) 263-5731
(208) 265-4716
Mailing address
1327 SUPERIOR ST, SANDPOINT, ID 83864-1735
(208) 263-5731
(208) 265-4716
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-094
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010008010
REGENCE BLUE SHIELD
ID
01
—
T0049
BLUE CROSS OF IDAHO
ID
Enumeration date
01/10/2007
Last updated
05/19/2011
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