Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 227.3680406 | IL |
NPI | 1013261999 |
---|---|
Provider Name | Shirley Ann Gerebizza |
First Address | Cary, IL 60013-1760 |
Second Address | Mchenry, IL 60050-5506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2012 |
Last Update Date | 19/12/2013 |