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General NPI Number Information
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NPI Number | 1578282927
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Entity Type | Individual
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Provider Name | PEARL AMANDA LASKY LMT
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Gender | Female
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 115 N MARION ST STE 10
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City | OAK PARK
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State | IL
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Zip | 60301-1503
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Country | US
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Telephone | 630-926-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 115 N MARION ST STE 8
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City | OAK PARK
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State | IL
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Zip | 60301-1503
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Country | US
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Telephone | 630-926-1778
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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 | 227021255
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198001669
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License Number State | IL
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