Healthcare Provider Details

I. General information

NPI: 1053928697
Provider Name (Legal Business Name): BONNIE LAINE LASHER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33772 COPPER LANTERN ST APT C
DANA POINT CA
92629-6427
US

IV. Provider business mailing address

34145 PACIFIC COAST HWY # 116
DANA POINT CA
92629-2808
US

V. Phone/Fax

Practice location:
  • Phone: 619-988-7612
  • Fax:
Mailing address:
  • Phone: 619-988-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number294619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: