Provider Demographics
NPI:1861641177
Name:LEE, BONNIE M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:M
Other - Last Name:BURRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10460 WATERS AVE S.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178
Mailing Address - Country:US
Mailing Address - Phone:206-249-5532
Mailing Address - Fax:206-582-0811
Practice Address - Street 1:10460 WATERS AVE S.
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178
Practice Address - Country:US
Practice Address - Phone:206-249-5532
Practice Address - Fax:206-582-0811
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist