MEDICARE: ELIZABETH FOLEY-CAMPOS 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	227013858	IL

General Provider Information

NPI Number	:	1427403708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH FOLEY-CAMPOS LMT

Provider Business Mailing Address
First Line	:	2337 W THOMAS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3581
Country	:	US
Telephone Number	:	708-305-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2618 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7107
Country	:	US
Telephone Number	:	708-305-0968
Fax Number	:

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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