Healthcare Provider Details

I. General information

NPI: 1790800043
Provider Name (Legal Business Name): VERONICA E. MORENO LMT, CMTPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4332 N ELSTON AVE
CHICAGO IL
60641-2144
US

IV. Provider business mailing address

1628 N SAWYER AVE
CHICAGO IL
60647-4915
US

V. Phone/Fax

Practice location:
  • Phone: 773-604-5321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227006002
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number227006002
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: