Provider Demographics
NPI:1336859420
Name:BOONE, LYSIANNE SEIGLER (MT)
Entity Type:Individual
Prefix:
First Name:LYSIANNE
Middle Name:SEIGLER
Last Name:BOONE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 VZ COUNTY ROAD 3411
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169-7591
Mailing Address - Country:US
Mailing Address - Phone:972-400-0072
Mailing Address - Fax:
Practice Address - Street 1:891 VZ COUNTY ROAD 3411
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-7591
Practice Address - Country:US
Practice Address - Phone:972-400-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT100595225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT100595OtherMASSAGE THERAPY