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General NPI Number Information
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NPI Number | 1932663770
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Entity Type | Individual
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Provider Name | LEONEL J GONZALEZ MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/23/2021
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Provider Practice Location Address
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Address Line | 2018 S. MICHIGAN AVE L&A HEALING STUDIO
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-753-3249
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Fax | 866-530-1169
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Provider Business Mailing Address
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Address Line | 2018 S. MICHIGAN AVE L&A HEALING STUDIO
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-753-3249
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Fax | 866-530-1169
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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 | 227007565
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License Number State | IL
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