Individual
BRENTON D EBERSOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
8 N MISSOURI AVE, BELLEVILLE, IL 62220-3948
(618) 310-5995
Mailing address
8 N MISSOURI AVE, BELLEVILLE, IL 62220-3948
(618) 310-5995
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
2014007249
MO
225700000X
Massage Therapist
Primary
227.019517
IL
Other
Enumeration date
03/03/2017
Last updated
03/03/2017
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