MEDICARE: ZAIANA ANGELA MARTIN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	227.019240	IL

General Provider Information

NPI Number	:	1619549888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAIANA ANGELA MARTIN LMT

Provider Business Mailing Address
First Line	:	4852 W DIVERSEY AVE APT 2R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1700
Country	:	US
Telephone Number	:	847-338-7613
Fax Number	:

Provider Business Practice Location Address
First Line	:	4852 W DIVERSEY AVE APT 2R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1700
Country	:	US
Telephone Number	:	847-338-7613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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