Provider Demographics
NPI:1851059059
Name:MOULTON, EULONDA (LMT)
Entity type:Individual
Prefix:MS
First Name:EULONDA
Middle Name:
Last Name:MOULTON
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 1:7435 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1542
Mailing Address - Country:US
Mailing Address - Phone:708-613-5255
Mailing Address - Fax:708-290-7434
Practice Address - Street 1:7435 MADISON ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1542
Practice Address - Country:US
Practice Address - Phone:708-613-5255
Practice Address - Fax:708-290-7434
Is Sole Proprietor?:No
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227022063225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist