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NPI Code Detail

MEDICARE: MS. GINA M. TOTTEN L.M.T.

MEDICARE:  MS. GINA M. TOTTEN  L.M.T.
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
1225700000XMassage Therapist227 007756IL

General Provider Information

NPI Number : 1578777363
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GINA M. TOTTEN L.M.T.
Provider Business Mailing Address
First Line : 3178 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4509
Country : US
Telephone Number : 773-549-6400
Fax Number :
Provider Business Practice Location Address
First Line : 3178 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4509
Country : US
Telephone Number : 773-549-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 03/07/2012

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Directions to “ MS. GINA M. TOTTEN L.M.T.” Practice Location

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