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General NPI Number Information
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NPI Number | 1942988472
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Entity Type | Individual
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Provider Name | PRINTISS E MUNN JR. LMT, MMP
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Gender | Male
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 1742 W ROSEHILL DR
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City | CHICAGO
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State | IL
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Zip | 60660-3920
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Country | US
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Telephone | 773-885-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 W GRANVILLE AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60660-1866
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Country | US
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Telephone | 773-885-5491
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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 | 227019799
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License Number State | IL
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