Provider Demographics
NPI:1184156374
Name:PETERS, NANCY V (LMT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:V
Last Name:PETERS
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 1:18630 W COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2222
Mailing Address - Country:US
Mailing Address - Phone:847-370-2785
Mailing Address - Fax:
Practice Address - Street 1:150 E COOK AVE STE 101
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2060
Practice Address - Country:US
Practice Address - Phone:847-370-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.000343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist