Provider Demographics
NPI:1942988472
Name:MUNN, PRINTISS E JR (LMT, MMP)
Entity Type:Individual
Prefix:MR
First Name:PRINTISS
Middle Name:E
Last Name:MUNN
Suffix:JR
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W GRANVILLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1866
Mailing Address - Country:US
Mailing Address - Phone:773-885-5491
Mailing Address - Fax:
Practice Address - Street 1:1742 W ROSEHILL DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3920
Practice Address - Country:US
Practice Address - Phone:773-885-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227019799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist