MEDICARE: LATONYA COLE

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	227044083	IL

General Provider Information

NPI Number	:	1871277152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONYA COLE

Provider Business Mailing Address
First Line	:	47 W POLK ST STE 600
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2000
Country	:	US
Telephone Number	:	773-904-3790
Fax Number	:

Provider Business Practice Location Address
First Line	:	3345 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3838
Country	:	US
Telephone Number	:	773-904-3790
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ LATONYA COLE ” Practice Location

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