Provider Demographics
NPI:1194038679
Name:BOUNDS, ELIZABETH DAVENPORT (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DAVENPORT
Last Name:BOUNDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 W CHANDLER BLVD APT 1116
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3896
Mailing Address - Country:US
Mailing Address - Phone:480-577-2151
Mailing Address - Fax:
Practice Address - Street 1:3800 W CHANDLER BLVD APT 1116
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3896
Practice Address - Country:US
Practice Address - Phone:480-577-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-07210225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist