MEDICARE: PAUL W. NORDEN RCST, 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	227-004434	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	227-004434	OTHER	IL	LICENSED MASSAGE THERAPST

General Provider Information

NPI Number	:	1821089772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL W. NORDEN RCST, LMT

Provider Business Mailing Address
First Line	:	4915 N ALBANY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-7431
Country	:	US
Telephone Number	:	773-294-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 N ALBANY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-4205
Country	:	US
Telephone Number	:	773-583-7959
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	12/07/2021

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