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NPI Code Detail

MEDICARE: MRS. MARNI MARIE BEALS ATC, LMT

MEDICARE: MRS. MARNI MARIE BEALS ATC, 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
12255A2300XAthletic TrainerIL
2225700000XMassage TherapistIL

General Provider Information

NPI Number : 1871566034
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARNI MARIE BEALS ATC, LMT
Provider Business Mailing Address
First Line : 408 N 5TH AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-1138
Country : US
Telephone Number : 312-236-0660
Fax Number : 312-236-1219
Provider Business Practice Location Address
First Line : 20 N MICHIGAN AVE
Second Line : SUITE 103
City : CHICAGO
State : IL
Zip : 60602-4811
Country : US
Telephone Number : 312-236-0660
Fax Number : 312-236-1219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 09/11/2025

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