MEDICARE: ALYSSA SORACCO 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	227006816	IL

General Provider Information

NPI Number	:	1477908051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA SORACCO LMT

Provider Business Mailing Address
First Line	:	4976 N MILWAUKEE AVE APT 501
Second Line	:	BARE BONES BODYWORK
City	:	CHICAGO
State	:	IL
Zip	:	60630-2174
Country	:	US
Telephone Number	:	312-388-3374
Fax Number	:

Provider Business Practice Location Address
First Line	:	4941 W FOSTER AVE
Second Line	:	BARE BONES BODYWORK
City	:	CHICAGO
State	:	IL
Zip	:	60630-1635
Country	:	US
Telephone Number	:	312-388-3374
Fax Number	:

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

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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