Individual
MR. JAMES CHARLES SOUKUP JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
310 4TH ST, AURORA, IN 47001-1206
(812) 560-8697
Mailing address
310 4TH ST, AURORA, IN 47001-1206
(812) 560-8697
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT21204228
IN
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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