Individual
MS. BONITA LYNN DESPAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2201 KEENAN DR, INTERNATIONAL FALLS, MN 56649-2152
(218) 283-8313
Mailing address
422 7TH ST # 1, INTERNATIONAL FALLS, MN 56649-2619
(309) 502-1408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2015026804
MO
225200000X
Physical Therapy Assistant
160.005650
IL
225200000X
Physical Therapy Assistant
Primary
A2779
MN
Other
Enumeration date
09/18/2015
Last updated
05/25/2022
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