Provider Demographics
NPI:1013285675
Name:RHEAULT, BONNIE SUE (LMT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:RHEAULT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:RHEAULT
Other - Last Name:WYZYKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:645 ELM CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1818
Mailing Address - Country:US
Mailing Address - Phone:407-697-0697
Mailing Address - Fax:407-668-4100
Practice Address - Street 1:224 W CENTRAL PKWY
Practice Address - Street 2:SUITE 1010
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2545
Practice Address - Country:US
Practice Address - Phone:407-697-0697
Practice Address - Fax:407-668-4100
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist