Individual
MRS. THERESA BONIFANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1750 S 20TH ST, LINCOLN, NE 68502-2611
(402) 475-6791
Mailing address
488 L RD, PALMYRA, NE 68418-4075
(402) 432-4358
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1583
NE
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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