Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2016037470 | MO |
NPI | 1013572882 |
---|---|
Provider Name | Mr. Charles William Steffy III |
First Address | Saint Louis, MO 63119-4331 |
Second Address | Glenview, IL 60026-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2019 |
Last Update Date | 07/05/2019 |