Provider Demographics
NPI:1083366835
Name:HASTINGS, BONNIE MARIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10562 SLEEMAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8515
Mailing Address - Country:US
Mailing Address - Phone:512-294-3030
Mailing Address - Fax:
Practice Address - Street 1:725 W ALDER ST STE 20
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4099
Practice Address - Country:US
Practice Address - Phone:406-493-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT046978225700000X
MTLMT-LIC-11815225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist