Healthcare Provider Details

I. General information

NPI: 1457340820
Provider Name (Legal Business Name): RONALD RAYMOND STEINWEHR JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 BAYSIDE DR
PALM COAST FL
32137-8818
US

IV. Provider business mailing address

191 BAYSIDE DR
PALM COAST FL
32137-8818
US

V. Phone/Fax

Practice location:
  • Phone: 386-246-3223
  • Fax:
Mailing address:
  • Phone: 386-246-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: