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1144496928
MARCIANO FUNTILA MONDALA
CHAMPAIGN, IL
NPI
1144496928
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: IL 070013083)
Enumeration Date
2008-05-01
Last Update Date
2008-05-01
Business Address
Mr. MARCIANO FUNTILA MONDALA
3207 EDWARD HOFFMAN DR
CHAMPAIGN, IL 61822-8018
Phone number: 217-356-8623
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Mailing Address
Mr. MARCIANO FUNTILA MONDALA
1001 E PELLS ST
PAXTON, IL 60957-1300
Phone number: 217-379-4361
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