Individual
MR. CLARK EDMON STULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2605 BREWERTON RD, SYRACUSE, NY 13211-1147
(315) 455-9355
Mailing address
17 FLOWER LN, MARCELLUS, NY 13108-1346
(315) 380-6719
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
024325
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024325
NY STATE EDUCATION DEPARTMENT
NY
Enumeration date
10/19/2010
Last updated
10/19/2010
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