Provider Demographics
NPI:1245883206
Name:QUINONES, GRISELLE (LMT, MMP)
Entity type:Individual
Prefix:
First Name:GRISELLE
Middle Name:
Last Name:QUINONES
Suffix:
Gender:
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 1:1626 W MONTROSE AVE # B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1214
Mailing Address - Country:US
Mailing Address - Phone:312-687-0224
Mailing Address - Fax:872-666-0790
Practice Address - Street 1:1626 W MONTROSE AVE # B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1214
Practice Address - Country:US
Practice Address - Phone:312-687-0224
Practice Address - Fax:872-666-0790
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227019472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist