MEDICARE: MS. EUNICE SUMMERS 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	227013113	IL

General Provider Information

NPI Number	:	1629411699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EUNICE SUMMERS LMT

Provider Business Mailing Address
First Line	:	4655 S LAKE PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4532
Country	:	US
Telephone Number	:	312-450-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	4655 S LAKE PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4532
Country	:	US
Telephone Number	:	312-450-9307
Fax Number	:

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

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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