Provider Demographics
NPI:1255461166
Name:BOND, MARIE CARNEVALE (MS, LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:CARNEVALE
Last Name:BOND
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:ELAINE
Other - Last Name:CARNEVALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259-0531
Mailing Address - Country:US
Mailing Address - Phone:817-875-0603
Mailing Address - Fax:940-479-2327
Practice Address - Street 1:597 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:PONDER
Practice Address - State:TX
Practice Address - Zip Code:76259-4406
Practice Address - Country:US
Practice Address - Phone:817-875-0603
Practice Address - Fax:940-479-2327
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT20302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer