Individual
JACQUELINE BONAVENTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
6149 S RAINBOW BLVD, LAS VEGAS, NV 89118-3250
(702) 900-9669
Mailing address
962 DERRINGER LN, HENDERSON, NV 89014-2592
(843) 906-5359
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3809
NV
Other
Enumeration date
09/19/2018
Last updated
09/19/2018
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