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NPI Code Detail

MEDICARE: MS. BONNIE CORTEZ MASSAGE THERAPIST

MEDICARE: MS. BONNIE CORTEZ MASSAGE THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist227014048IL

General Provider Information

NPI Number : 1205224599
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BONNIE CORTEZ MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 1628 ESTATE CIR
Second Line :
City : NAPERVILLE
State : IL
Zip : 60565-6789
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1628 ESTATE CIR
Second Line :
City : NAPERVILLE
State : IL
Zip : 60565-6789
Country : US
Telephone Number : 262-844-5199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2015
Last Update Date : 01/08/2015

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