Individual
LESLIE WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
314 W SUPERIOR ST, LL-E, LATERAL FITNESS, CHICAGO, IL 60654-3538
(912) 220-1062
Mailing address
1403 W PALM DR, MOUNT PROSPECT, IL 60056-4528
(912) 220-1062
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227010419
IL
Other
Enumeration date
03/28/2017
Last updated
03/28/2017
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