Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA48041 | FL |
NPI | 1013285675 |
---|---|
Provider Name | Bonnie Sue Rheault |
First Address | Altamonte Springs, FL 32714-1818 |
Second Address | Altamonte Springs, FL 32714-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2011 |
Last Update Date | 09/12/2011 |