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Individual

HUMBERTO MEDINA JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC, LMT

Contact information

Practice address
721 HOBART DR UNIT A, SOUTH ELGIN, IL 60177-3082
(630) 508-2386
Mailing address
721 HOBART DR UNIT A, SOUTH ELGIN, IL 60177-3082
(630) 508-2386

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096.001490
IL
225700000X
Massage Therapist
Primary
227.014634
IL

Other

Enumeration date
02/03/2016
Last updated
02/03/2016
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