TIMOTHY PATRICK BONACUM (NPI# 1164990461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164990461 |
| Entity Type | Individual |
| Full Name | TIMOTHY PATRICK BONACUM |
| Credential | PT, DPT, ATC |
| Practice Address |
771 Chestnut Rd East Lansing MI 48824-3434 |
| Mailing Address |
310 N Cedar St Apt 416 Lansing MI 48912-1224 |
| Practice Telephone | 5173531655 |
| Mailing Telephone | 9082940105 |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2019-09-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | 5501019249 | MI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
2601002288 | MI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 239 Park Ave, Portland, ME 041022911 | 9082940105 |
| Street Address |
771 CHESTNUT RD |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-3434 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124448436 | David Jager | Specialist/Technologist | 771 Chestnut Rd, East Lansing, MI 48824-4408 | 2014-04-25 |
| 1669022216 | Colten I Seibel | Specialist/Technologist | 771 Chestnut Rd, East Lansing, MI 48824-3434 | 2019-09-16 |
| 1679036321 | Lianna Hadden | Specialist/Technologist | 771 Chestnut Rd, East Lansing, MI 48824-3434 | 2019-04-10 |
| 1225570641 | Tamaria Hibbler | Specialist/Technologist | 771 Chestnut Rd, East Lansing, MI 48824-3434 | 2016-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912548926 | Monica Grimes | Specialist/Technologist | 1536 Snyder Rd, East Lansing, MI 48823-3746 | 2019-10-01 |
| 1760033211 | Nina Sebastian | Specialist/Technologist | 393 Chestnut Rd, East Lansing, MI 48824-5401 | 2019-09-26 |
| 1427608033 | Kyle Newood | Specialist/Technologist | 393 Chestnut Rd Rm 211, East Lansing, MI 48824-5401 | 2019-09-16 |
| 1972088383 | Isabelle Lee Clarke | Specialist/Technologist | 430 Rosewood Ave, East Lansing, MI 48823-3245 | 2018-10-02 |
| 1891207502 | Julia Kulhawik | Specialist/Technologist | 735 E Shaw Ln, East Lansing, MI 48825-3802 | 2017-11-03 |
| 1083065213 | Caroline Lisee | Specialist/Technologist | 1 Im Sports Cir, 308 W. Circle Drive, East Lansing, MI 48824-1049 | 2016-06-29 |
| 1245684570 | Vincent Paul Delvalle | Specialist/Technologist | 223 Kalamazoo St Ste 106, East Lansing, MI 48824-5400 | 2016-04-23 |
| 1417313297 | Tracey Covassin | Specialist/Technologist | 308 W Circle Dr, Department of Kineisology Michigan State University, East Lansing, MI 48824-3700 | 2016-01-08 |
| 1124448436 | David Jager | Specialist/Technologist | 771 Chestnut Rd, East Lansing, MI 48824-4408 | 2014-04-25 |
| 1619249943 | Michael Little | Specialist/Technologist | 2900 Hannah Boulevard, Sports Medicine Suite B102, East Lansing, MI 48823-5374 | 2012-02-02 |
| Find all providers in EAST LANSING | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.