Individual
PHILLIP G STATLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1752 WINDSOR RD, LOVES PARK, IL 61111-4280
(815) 977-3747
Mailing address
10206 LEANA DR, ROSCOE, IL 61073-6412
(815) 979-5893
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.019355
IL
Other
Enumeration date
09/20/2018
Last updated
09/20/2018
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