Provider Demographics
NPI:1417171430
Name:POPP, RICHARD JOHN (MT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOHN
Last Name:POPP
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 BAY COLONY DR
Mailing Address - Street 2:#2S
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3745
Mailing Address - Country:US
Mailing Address - Phone:847-824-0585
Mailing Address - Fax:
Practice Address - Street 1:9359 BAY COLONY DR
Practice Address - Street 2:#2S
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3745
Practice Address - Country:US
Practice Address - Phone:847-824-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist