Doctor Name: | MRS. JANELL DIANE MOSBACH |
NPI Number: | 1063775856 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 227-010226 |
Business Practice Address: | 2401 E Washington St Bloomington, IL - 617044480 |
Business Phone Number: | 2173046487 |
Business Fax Number: | 3096612892 |
Mailing Address: | 2401 E Washington St, BLOOMINGTON |
State: | IL |
Postal Code: | 617044480 |
Phone Number: | 2173046487 |
Fax Number: | 3096612892 |
NPI Enumeration Date: | 06/18/2012 |
NPI Last Update Date: | 06/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 227-010226 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |