Individual
KEITH DESTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
320 HIGH RIDGE RD, HILLSIDE, IL 60162-1621
(708) 420-8923
Mailing address
320 HIGH RIDGE RD, HILLSIDE, IL 60162-1621
(708) 420-8923
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227013561
IL
Other
Enumeration date
07/15/2014
Last updated
07/15/2014
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