Individual
THERON C STATLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA, LMT
Contact information
Practice address
4400 AIRWAY RD, DAYTON, OH 45431-1330
(937) 241-5837
Mailing address
4400 AIRWAY RD, DAYTON, OH 45431-1330
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-06680
OH
225700000X
Massage Therapist
LMT 33.011673
OH
Other
Enumeration date
01/14/2008
Last updated
08/26/2008
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