Individual
MR. DERRICK A POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
586 S ROSEHALL LN, ROUND LAKE, IL 60073-4268
(847) 505-6944
Mailing address
586 S ROSEHALL LN, ROUND LAKE, IL 60073-4268
(847) 505-6944
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.022514
IL
225700000X
Massage Therapist
227022514
IL
Other
Enumeration date
05/07/2022
Last updated
05/07/2022
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