Doctor Name: | THERON C STATLER |
NPI Number: | 1235315839 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PTA, LMT |
License Number: | LMT 33.011673 |
Business Practice Address: | 4400 Airway Rd Dayton, OH - 454311330 |
Business Phone Number: | 9372415837 |
Business Fax Number: | |
Mailing Address: | 4400 Airway Rd, DAYTON |
State: | OH |
Postal Code: | 454311330 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/14/2008 |
NPI Last Update Date: | 08/26/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | LMT 33.011673 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |