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NPI Code Detail

MEDICARE: ANTIONETTE M MEREDITH LMT

MEDICARE:   ANTIONETTE M MEREDITH  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
1225700000XMassage Therapist227022984IL

General Provider Information

NPI Number : 1801632716
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTIONETTE M MEREDITH LMT
Provider Business Mailing Address
First Line : 500 COVENTRY LN STE 130
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-7578
Country : US
Telephone Number : 630-418-4440
Fax Number :
Provider Business Practice Location Address
First Line : 500 COVENTRY LN STE 130
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-7578
Country : US
Telephone Number : 630-418-4440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2024
Last Update Date : 07/01/2024

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Directions to “ ANTIONETTE M MEREDITH LMT” Practice Location

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