Provider Demographics
NPI:1932663770
Name:GONZALEZ, LEONEL J (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:J
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 S. MICHIGAN AVE
Mailing Address - Street 2:L&A HEALING STUDIO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-753-3249
Mailing Address - Fax:866-530-1169
Practice Address - Street 1:2018 S. MICHIGAN AVE
Practice Address - Street 2:L&A HEALING STUDIO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-753-3249
Practice Address - Fax:866-530-1169
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227007565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL474193873OtherEIN NUMBER