Provider Demographics
NPI:1538442629
Name:PARRILL, BONITA I (LMP)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:I
Last Name:PARRILL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10603 52ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2050
Mailing Address - Country:US
Mailing Address - Phone:360-652-3767
Mailing Address - Fax:
Practice Address - Street 1:7104 265TH ST NW
Practice Address - Street 2:SUITE 130
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6250
Practice Address - Country:US
Practice Address - Phone:425-263-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60237206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist