MEDICARE: KIMBERLY CAROLLO 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	227.011066	IL

General Provider Information

NPI Number	:	1649667064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CAROLLO LMT

Provider Business Mailing Address
First Line	:	50 E GREENBRIAR AVE
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1826
Country	:	US
Telephone Number	:	708-541-0132
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 E GREENBRIAR AVE
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1826
Country	:	US
Telephone Number	:	708-541-0132
Fax Number	:

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

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	08/20/2016

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Directions to “ KIMBERLY CAROLLO LMT” Practice Location

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