Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 227016113 | IL |
NPI | 1003204314 |
---|---|
Provider Name | Sabas Shawn Uriostegui |
First Address | Chicago, IL 60629-3227 |
Second Address | Chicago, IL 60616-5520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2015 |
Last Update Date | 08/01/2015 |