Provider Demographics
NPI:1750525887
Name:MUSKOVIN, JEFFREY N (LMT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:N
Last Name:MUSKOVIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SHERMAN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5038
Mailing Address - Country:US
Mailing Address - Phone:847-778-7020
Mailing Address - Fax:
Practice Address - Street 1:1601 SHERMAN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5038
Practice Address - Country:US
Practice Address - Phone:847-778-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227003856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist