MR. Derrick A Powell, LMT

NPI #1487390084 in Round Lake, Illinois

Provider Information

NPI Number: 1487390084
Entity Type: Individual
Name: MR. Derrick A Powell, LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT
Enumeration Date: May 7, 2022
Last Updated: May 7, 2022

Practice Location

Address: 586 S ROSEHALL LN
City: Round Lake
State: Illinois
ZIP Code: 60073-4268
Phone: (847) 505-6944

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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