Individual
KYLE STUENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 LAFAYETTE AVE, MATTOON, IL 61938-4409
(217) 235-5449
Mailing address
201 LAFAYETTE AVE, MATTOON, IL 61938-4409
(217) 235-5449
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.003934
IL
Other
Enumeration date
10/01/2012
Last updated
10/01/2012
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