Individual
MR. MICHAEL ROBERT DAMBACHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
95 STONEY DR, DUPO, IL 62239-1160
(618) 365-0249
Mailing address
95 STONEY DR, DUPO, IL 62239-1160
(618) 365-0249
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2016002048
MO
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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