Provider Demographics
NPI:1396033247
Name:WESTBROOK, NANCY JUANITA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JUANITA
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10118 BLUEBONNET DRIVE
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1315
Mailing Address - Country:US
Mailing Address - Phone:815-633-5158
Mailing Address - Fax:815-633-5158
Practice Address - Street 1:10118 BLUEBONNET DRIVE
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1315
Practice Address - Country:US
Practice Address - Phone:815-633-5158
Practice Address - Fax:815-633-5158
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.006997225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist