Individual
BONNIE DURHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
11911 CLOVITE CT, ALEDO, TX 76008-3509
(817) 312-4536
Mailing address
PO BOX 121471, FORT WORTH, TX 76121-1471
(817) 312-4536
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT014694
TX
Other
Enumeration date
09/13/2020
Last updated
09/13/2020
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