Gwenn None Marie, BCPP, BCTMB, LMT
Massage Therapist in Bloomington, IL. Individual provider (NPI-1).
NPI number1164043113
StatusActive
Last updated in NPPESApr 30, 2020
Details
- NPI
- 1164043113
- Entity type
- Individual (NPI-1)
- Name
- Gwenn None Marie
- Credential
- BCPP, BCTMB, LMT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 30, 2020
- Certification date
- Apr 30, 2020
- Last updated
- Apr 30, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 227.001257 | IL | Yes |
Practice location
2416 E Washington St Ste A9Bloomington, IL 61704-1612
Phone 309-310-6472
Mailing address
13 Broadway PlNormal, IL 61761-3620
Phone 309-310-6472
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