Provider Demographics
NPI:1588933469
Name:SCIORTINO, TAMARA LYNNE (LAT,LMT,CES)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LYNNE
Last Name:SCIORTINO
Suffix:
Gender:F
Credentials:LAT,LMT,CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 N HERMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3907
Mailing Address - Country:US
Mailing Address - Phone:630-272-2501
Mailing Address - Fax:708-492-5624
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:STE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:708-236-2624
Practice Address - Fax:708-492-5624
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0013672255A2300X
IL227.000618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist