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Mr. Clark Edmon Stull, LMT
Massage Therapist in Syracuse, New York
NPI 1558671941

Clark Edmon Stull is a Massage Therapist based in Marcellus, NY. Clark Edmon Stull practices in Syracuse, NY and has the professional credentials of LMT. The NPI Number for Clark Edmon Stull is 1558671941 and holds a License No. 024325 (New York).

The current practice location address for Clark Edmon Stull is 2605 Brewerton Rd, Syracuse, NY and can be reached out via phone at 315-455-9355. You can also correspond with Clark Edmon Stull through the mailing address at 17 FLOWER LN, MARCELLUS, NY - 13108-1346 (mailing address contact number: 315-380-6719).

Location: 2605 Brewerton Rd, Syracuse, NY, 13108-1346
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1558671941
Provider Name
Clark Edmon Stull
Credential
LMT
Provider Entity Type
Individual
Gender
Male
Address
2605 Brewerton Rd, Syracuse, NY, 13108-1346
Phone Number
315-455-9355
Fax Number
Provider Enumeration Date
10/19/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
024325 01 NY NY STATE EDUCATION DEPARTMENT
institution
Provider Business Practice Location Address Details
Address
2605 Brewerton Rd
City
Syracuse
State
New York
Zip
13211-1147
Phone Number
315-455-9355
Fax Number
person
Provider Business Mailing Address Details
Address
2605 Brewerton Rd
City
Syracuse
State
New York
Zip
13211-1147
Phone Number
315-455-9355
Fax Number
person
Provider's Taxonomy Details 1
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Massage Therapist
Speciality
-
Taxonomy
225700000X
License No.
024325 (New York)
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.
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