Healthcare Provider Details

I. General information

NPI: 1073447272
Provider Name (Legal Business Name): MAREK RAFALO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N ROSE AVE
PARK RIDGE IL
60068-2961
US

IV. Provider business mailing address

409 N ROSE AVE
PARK RIDGE IL
60068-2961
US

V. Phone/Fax

Practice location:
  • Phone: 773-895-2441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227023663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: