MEDICARE: GRISELLE QUINONES LMT, MMP

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
1	225700000X	Massage Therapist	227019472	IL

General Provider Information

NPI Number	:	1245883206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISELLE QUINONES LMT, MMP

Provider Business Mailing Address
First Line	:	1626 W MONTROSE AVE # B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1214
Country	:	US
Telephone Number	:	312-687-0224
Fax Number	:	872-666-0790

Provider Business Practice Location Address
First Line	:	1626 W MONTROSE AVE # B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1214
Country	:	US
Telephone Number	:	312-687-0224
Fax Number	:	872-666-0790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	03/06/2025

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