Individual
MR. DANIEL PRUDENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2907 WILLIAMSON COUNTY PKWY, MARION, IL 62959-5256
(618) 998-9993
Mailing address
2907 WILLIAMSON COUNTY PKWY, MARION, IL 62959-5256
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160004507
IL
Other
Enumeration date
01/18/2011
Last updated
01/18/2011
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