Individual
MR. KYLE BRUNSMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSR, LMT
Contact information
Practice address
211 LEBANON AVE, BELLEVILLE, IL 62220-4124
(618) 619-8200
Mailing address
2706 E MAIN ST, BELLEVILLE, IL 62221-5034
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.020355
IL
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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