Individual
MS. REGINA SUE BONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6905 E STATE ST, ROCKFORD, IL 61108-2692
(815) 397-4142
Mailing address
PO BOX 6107, ROCKFORD, IL 61125-1107
(815) 397-4142
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227013896
LICENSED MASSAGE THERAPIST
IL
01
—
610557-11
NATIONAL CERTIFIED IN THERAPEUTIC MASSAGE AND BODYWORK
—
Enumeration date
07/10/2013
Last updated
07/10/2013
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