Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | 2018003451 | MO |
NPI | 1013142884 |
---|---|
Provider Name | Dr. Steve Middleton |
First Address | Fulton, MO 65251-1719 |
Second Address | Carbondale, IL 62901-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2009 |
Last Update Date | 08/02/2018 |