Doctor Name: | MS. LESLIE ANNE MALACH |
NPI Number: | 1790002137 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCMT |
License Number: | 22.006885 |
Business Practice Address: | 500 Autumn Blvd #104 Lakemoor, IL - 600516683 |
Business Phone Number: | 2246290367 |
Business Fax Number: | |
Mailing Address: | 500 Autumn Blvd, #104 LAKEMOOR |
State: | IL |
Postal Code: | 600516683 |
Phone Number: | 2246290367 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2010 |
NPI Last Update Date: | 04/26/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 22.006885 |
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. |