Provider Demographics
NPI:1538598628
Name:BONNEY, LISA ANN (LMT MMP MLDT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BONNEY
Suffix:
Gender:F
Credentials:LMT MMP MLDT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:KITCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT MMP MLDT
Mailing Address - Street 1:1012 SAGEWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131
Mailing Address - Country:US
Mailing Address - Phone:817-781-0772
Mailing Address - Fax:
Practice Address - Street 1:1012 SAGEWOOD LANE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131
Practice Address - Country:US
Practice Address - Phone:817-781-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114793225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist