Provider Demographics
NPI:1598968562
Name:DAVIS, BONNIE J (LMT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:DAVIS
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 1:8500 BELCHER RD
Mailing Address - Street 2:APARTMENT 1204
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1015
Mailing Address - Country:US
Mailing Address - Phone:727-239-3265
Mailing Address - Fax:
Practice Address - Street 1:8500 BELCHER RD
Practice Address - Street 2:APARTMENT 1204
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1015
Practice Address - Country:US
Practice Address - Phone:727-239-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMA26242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA26242OtherSTATE LICENSE