Provider Demographics
NPI:1285902965
Name:BONJORNI, LYNETTE DOROTHY (LMT)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:DOROTHY
Last Name:BONJORNI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16720 SE 45TH CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-6129
Mailing Address - Country:US
Mailing Address - Phone:352-245-1074
Mailing Address - Fax:
Practice Address - Street 1:11407 SE HWY 301, SUITE 3
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420
Practice Address - Country:US
Practice Address - Phone:352-245-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 0009470172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist