MEDICARE: DENNIS FRYMIRE LMT

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

General Provider Information

NPI Number	:	1295349959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS FRYMIRE LMT

Provider Business Mailing Address
First Line	:	4955 N MONTICELLO AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5617
Country	:	US
Telephone Number	:	773-332-6705
Fax Number	:

Provider Business Practice Location Address
First Line	:	4955 N MONTICELLO AVE # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5617
Country	:	US
Telephone Number	:	773-332-6705
Fax Number	:

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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