Individual
MS. BONITA STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
198 SAWNEY CREEK CIR, RIDGEWAY, SC 29130-7104
(803) 237-5733
Mailing address
198 SAWNEY CREEK CIR, RIDGEWAY, SC 29130-7104
(803) 237-5733
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
3474
SC
Other
Enumeration date
03/17/2016
Last updated
01/27/2025
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