Basic Information
| Provider Information | |||||||||
| NPI: | 1780920348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONK | ||||||||
| FirstName: | KRISTI | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1518 LAKEMOOR LOOP SW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985125535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603292655 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 312 COLUMBIA ST NW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985011031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603571390 | ||||||||
| FaxNumber: | 3603571391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2012 | ||||||||
| LastUpdateDate: | 12/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172M00000X | MA 60305968 | WA | Y | Other Service Providers | Mechanotherapist |
No ID Information.