Individual
MRS. GAYLE BONZER-FRY
Active
Individual
MRS. GAYLE BONZER-FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT-081
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010008652
BLUE SHIELD
ID
05
—
804131800
—
ID
01
—
T0239
BLUE CROSS OF IDAHO
ID
Enumeration date
08/30/2005
Last updated
07/22/2013
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