Individual
TERESA LYN BONAWITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
9104 NE HIGHWAY 99, VANCOUVER, WA 98665-8925
(360) 773-5073
Mailing address
13306 NE 92ND ST, VANCOUVER, WA 98682-3051
(360) 260-0082
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA60042214
WA
Other
Enumeration date
05/19/2010
Last updated
05/19/2010
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