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1487212510
ETHAN DALE LUTTRELL
ELDON, MO
NPI
1487212510
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: MO 2019018423)
Enumeration Date
2019-06-04
Last Update Date
2019-06-04
Business Address
ETHAN DALE LUTTRELL
302 E 4TH ST
ELDON, MO 65026-1808
Phone number: 573-392-3000
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Mailing Address
ETHAN DALE LUTTRELL
302 E 4TH ST
ELDON, MO 65026-1808
Phone number:
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