Provider Demographics
NPI:1215370671
Name:KILMAN, BONNIE ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ANNE
Last Name:KILMAN
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 1:309 JERRY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2489
Mailing Address - Country:US
Mailing Address - Phone:720-849-6162
Mailing Address - Fax:
Practice Address - Street 1:309 JERRY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2489
Practice Address - Country:US
Practice Address - Phone:720-849-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist