Provider Demographics
NPI:1104232446
Name:NEILL, TASHA K (LMT)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:K
Last Name:NEILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1633
Mailing Address - Country:US
Mailing Address - Phone:618-524-8300
Mailing Address - Fax:618-524-8607
Practice Address - Street 1:723 MARKET ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1633
Practice Address - Country:US
Practice Address - Phone:618-524-8300
Practice Address - Fax:618-524-8607
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.010096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist