MEDICARE: TASSANEE FULLONE

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	227.021245	IL

General Provider Information

NPI Number	:	1528990124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASSANEE FULLONE

Provider Business Mailing Address
First Line	:	847 N CENTER ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-3142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 N CENTER ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-3142
Country	:	US
Telephone Number	:	331-215-4054
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ TASSANEE FULLONE ” Practice Location

Language	Start Address	Practice Location

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