Individual
DUSTIN CRAIGMYLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2800 S FORT AVE, SPRINGFIELD, MO 65807-3480
(417) 882-0035
Mailing address
2800 S FORT AVE, SPRINGFIELD, MO 65807-3480
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2022027243
MO
Other
Enumeration date
12/28/2022
Last updated
12/28/2022
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