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General NPI Number Information
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NPI Number | 1013261999
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Entity Type | Individual
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Provider Name | SHIRLEY ANN GEREBIZZA LMT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 413 FRONT ST
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City | MCHENRY
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State | IL
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Zip | 60050-5506
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Country | US
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Telephone | 815-759-5927
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Fax |
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Provider Business Mailing Address
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Address Line | 7410 S RAWSON BRIDGE RD
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City | CARY
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State | IL
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Zip | 60013-1760
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Country | US
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Telephone | 847-602-0619
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.3680406
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License Number State | IL
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