Lisa Marie Bonaventura, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

5139 Issued in SC

Practice address

1501 N Highway 17 Unit J
Mount Pleasant, SC 29464-3342

Phone

(843) 412-7033

Fax

(843) 412-7033

NPI assigned

Feb 11, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Lisa Marie Miller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518307200000",
    "number": "1578062014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 PLUFF MUD ALY",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294648149",
            "telephone_number": "843-412-7033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 N HIGHWAY 17 UNIT J",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643342",
            "telephone_number": "843-412-7033",
            "fax_number": "843-412-7033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAVENTURA",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-11",
        "last_updated": "2018-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "SC",
            "license": "5139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MILLER",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "LMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ruford Joseph Bolchoz Jr., D.M.D.
• Tamika M Bolden Ravenell, DPM
• John P Bolger, PH.D.
• Bon Secours St Francis Xavier Hospital, Inc.
• Bon Secours St. Francis Xavier Hosptial, Inc.
• Jason Carl Bonavito
• Walter Morse Bonner Jr., M.D.
• Pamela Bonning, RN
• Samantha Booth, DPT
• Anna Borden, D.D.S.

• Massage Therapist in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Massage Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.