Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 227.010271 | IL |
NPI | 1003312166 |
---|---|
Provider Name | Ms. Aleksandra Maria Gidzinski |
First Address | Carol Stream, IL 60188-9297 |
Second Address | Carol Stream, IL 60188-9297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2018 |
Last Update Date | 05/04/2018 |