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NPI Code Detail

MEDICARE: COLLEEN MCCULLOUGH LMT

MEDICARE: COLLEEN MCCULLOUGH 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
1225700000XMassage Therapist227017493IL

General Provider Information

NPI Number : 1700263852
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN MCCULLOUGH LMT
Provider Business Mailing Address
First Line : 7843 LINDER AVE
Second Line :
City : BURBANK
State : IL
Zip : 60459-1356
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5569 W 95TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2356
Country : US
Telephone Number : 708-717-5947
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2015
Last Update Date : 04/28/2015

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Directions to “ COLLEEN MCCULLOUGH LMT” Practice Location

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