CHAD DISTELRATH

FORT WAYNE, IN
NPI1962823138
Entity TypeIndividual
GenderN/A
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: IN  06002033A)
Enumeration Date2013-12-13
Last Update Date2013-12-13
Business Address
-- CHAD DISTELRATH
1717 MAPLECREST RD, APT 112
FORT WAYNE, IN 46815
Phone number: 260-493-0012
Mailing Address
-- CHAD DISTELRATH
3825 METER DRIVE
FORT WAYNE, IN 46806
Phone number:
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