Destine Nicole Haley, LMT
Individual provider Active NPI Massage Therapist · Richmond, IL
NPI 1053913848 · NPPES record last updated Nov 16, 2020
Key facts
- NPI
- 1053913848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 227.021923 (IL)
- Practice address
- 170 Cunat Blvd Apt 3D
Richmond, IL 60071-8964 - Phone
- (228) 343-9641
- NPI assigned
- Nov 16, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227.021923 | IL | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 227.021923 | IL | Yes |
Addresses
Primary practice location
170 Cunat Blvd Apt 3D
Richmond, IL 60071-8964
Mailing address
170 Cunat Blvd Apt 3D
Richmond, IL 60071-8964
Phone (228) 343-9641
Other providers in Richmond, IL
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- Raymond Louis Heppner Jr.
- Hilltop Haven Inc
- Kristy M Hinz
- Holistic Harmony Chiropractic & Wellness, PLLC
All providers in Richmond, IL · Massage Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.