Provider Demographics
NPI:1518284827
Name:LOVE, BONNIE E (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:E
Last Name:LOVE
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 1:7103 S COUNTY ROAD 475 E
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:IN
Mailing Address - Zip Code:46120-8989
Mailing Address - Country:US
Mailing Address - Phone:317-286-0531
Mailing Address - Fax:
Practice Address - Street 1:7103 S COUNTY ROAD 475 E
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:IN
Practice Address - Zip Code:46120-8989
Practice Address - Country:US
Practice Address - Phone:317-286-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20901080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist