Provider Demographics
NPI:1659904290
Name:BONNELL, SEREPHINE (CMT)
Entity Type:Individual
Prefix:
First Name:SEREPHINE
Middle Name:
Last Name:BONNELL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DOWNEY ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-1773
Mailing Address - Country:US
Mailing Address - Phone:719-251-6135
Mailing Address - Fax:
Practice Address - Street 1:807 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4419
Practice Address - Country:US
Practice Address - Phone:307-742-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist