Provider Demographics
NPI:1073882163
Name:EUBANKS, PAUL (LMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:EUBANKS
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 1:443 FINCH DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9558
Mailing Address - Country:US
Mailing Address - Phone:773-316-6775
Mailing Address - Fax:
Practice Address - Street 1:443 FINCH DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-9558
Practice Address - Country:US
Practice Address - Phone:773-316-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.008655225700000X
WI4988-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL227.008655OtherMASSAGE THERAPIST
WI4988-146OtherMASSAGE THERAPIST