Individual
MYKA STUTZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
900 N WASHINGTON ST, DU QUOIN, IL 62832-1233
(618) 542-2146
Mailing address
500 SALUKI BLVD APT 1226, CARBONDALE, IL 62903-8269
(309) 340-0909
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
160010047
IL
225200000X
Physical Therapy Assistant
160010047
IL
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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