Provider Demographics
NPI:1205229440
Name:DEVO, MICHAEL (LMT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DEVO
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 1:912 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3146
Mailing Address - Country:US
Mailing Address - Phone:847-624-1164
Mailing Address - Fax:
Practice Address - Street 1:524 W STATE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2154
Practice Address - Country:US
Practice Address - Phone:630-232-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227011153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist