Individual
MR. KYLE MICHAEL CHAMNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
374 E GRAND AVE, CARBONDALE, IL 62901-3962
(618) 453-1292
(618) 453-4290
Mailing address
PO BOX 125, HURST, IL 62949-0125
(618) 201-4121
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005944
IL
Other
Enumeration date
03/11/2013
Last updated
03/11/2013
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