Individual
MISS LISA MARIE BONAVENTURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1501 N HIGHWAY 17 UNIT J, MOUNT PLEASANT, SC 29464-3342
(843) 412-7033
(843) 412-7033
Mailing address
367 PLUFF MUD ALY, MOUNT PLEASANT, SC 29464-8149
(843) 412-7033
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
5139
SC
Other
Enumeration date
02/11/2018
Last updated
02/11/2018
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