Provider Demographics
NPI:1043583362
Name:MOROMI, MAURO (LMT)
Entity Type:Individual
Prefix:
First Name:MAURO
Middle Name:
Last Name:MOROMI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3476
Mailing Address - Country:US
Mailing Address - Phone:630-209-3487
Mailing Address - Fax:
Practice Address - Street 1:5151 MOCHEL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5076
Practice Address - Country:US
Practice Address - Phone:630-324-6019
Practice Address - Fax:630-324-6020
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227012489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist