Provider Demographics
NPI:1619549888
Name:MARTIN, ZAIANA ANGELA (LMT)
Entity Type:Individual
Prefix:
First Name:ZAIANA
Middle Name:ANGELA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MYNA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4852 W DIVERSEY AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1700
Mailing Address - Country:US
Mailing Address - Phone:847-338-7613
Mailing Address - Fax:
Practice Address - Street 1:4852 W DIVERSEY AVE APT 2R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1700
Practice Address - Country:US
Practice Address - Phone:847-338-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.019240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist