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Individual

DUSTIN STORCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.T.

Contact information

Practice address
1190 FORTUNE BLVD, SHILOH, IL 62269-7358
(314) 286-6988
Mailing address
RR 2 BOX 36, FARINA, IL 62838-9421
(618) 795-0667

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2007034391
MO
225100000X
Physical Therapist
Primary
70015924
IL
261QP2000X
Physical Therapy Clinic/Center
2007034391
MO

Other

Enumeration date
01/29/2008
Last updated
06/05/2024
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