Provider Demographics
NPI:1477908051
Name:SORACCO, ALYSSA (LMT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SORACCO
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 1:4976 N MILWAUKEE AVE APT 501
Mailing Address - Street 2:BARE BONES BODYWORK
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2174
Mailing Address - Country:US
Mailing Address - Phone:312-388-3374
Mailing Address - Fax:
Practice Address - Street 1:4941 W FOSTER AVE
Practice Address - Street 2:BARE BONES BODYWORK
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1635
Practice Address - Country:US
Practice Address - Phone:312-388-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227006816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist