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Individual

ETHAN DALE LUTTRELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
302 E 4TH ST, ELDON, MO 65026-1808
(573) 392-3000
Mailing address
302 E 4TH ST, ELDON, MO 65026-1808

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2019018423
MO

Other

Enumeration date
06/04/2019
Last updated
06/04/2019
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