MEDICARE: CHRISHENDA MCPHERSON 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	227.016318	IL

General Provider Information

NPI Number	:	1821653445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISHENDA MCPHERSON LMT

Provider Business Mailing Address
First Line	:	5214 S WOODLAWN AVE APT 411
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4435
Country	:	US
Telephone Number	:	312-522-8434
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 S WOODLAWN AVE APT 411
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4435
Country	:	US
Telephone Number	:	312-522-8434
Fax Number	:

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

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	05/08/2019

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