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NPI Code Detail

MEDICARE: MIATA LANAE MINOR

MEDICARE: MIATA LANAE MINOR
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 Therapist227.024341IL

General Provider Information

NPI Number : 1629938717
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIATA LANAE MINOR
Provider Business Mailing Address
First Line : 4307 S PRAIRIE AVE UNIT 312
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3725
Country : US
Telephone Number : 312-613-1651
Fax Number :
Provider Business Practice Location Address
First Line : 1614 E 53RD ST UNIT 21
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4210
Country : US
Telephone Number : 312-613-1651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2025
Last Update Date : 11/12/2025

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Directions to “ MIATA LANAE MINOR ” Practice Location

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