Individual
MR. DERRICK D DITZLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
59 S NINA ST, CORTLAND, IL 60112-4047
(815) 793-7737
Mailing address
59 S NINA ST, CORTLAND, IL 60112-4047
(815) 793-7737
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227012825
IL
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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