MEDICARE: MR. SHANE BLAKE STEIMEL MS, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05005982A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851485536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHANE BLAKE STEIMEL MS, PT

Provider Business Mailing Address
First Line	:	6922 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2040
Country	:	US
Telephone Number	:	317-621-7820
Fax Number	:	317-621-7824

Provider Business Practice Location Address
First Line	:	6922 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2040
Country	:	US
Telephone Number	:	317-621-7820
Fax Number	:	317-621-7824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/25/2012

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