Provider Demographics
NPI:1194468280
Name:MEDIMASSAGE LLC
Entity Type:Organization
Organization Name:MEDIMASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:JASMINE
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:I
Authorized Official - Credentials:CMT, PTA
Authorized Official - Phone:708-759-7903
Mailing Address - Street 1:1910 S. HIGHLAND AVE. UNIT 260
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-776-3043
Mailing Address - Fax:630-929-1390
Practice Address - Street 1:1910 S. HIGHLAND AVE. UNIT 260
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-776-3043
Practice Address - Fax:630-929-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service