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General NPI Number Information
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NPI Number | 1134828247
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Entity Type | Individual
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Provider Name | RENEE SOMAR RYAN LICENSED MASSAGE THE
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 0S 165 CHURCH STREET
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City | WINFIELD
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State | IL
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Zip | 60190-1245
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Country | US
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Telephone | 630-352-9097
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Fax |
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Provider Business Mailing Address
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Address Line | 612 EKLUND AVENUE
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City | GENEVA
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State | IL
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Zip | 60134-1334
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Country | US
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Telephone | 830-352-9097
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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 | 227.000464
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License Number State | IL
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