Healthcare Provider Details

I. General information

NPI: 1831194125
Provider Name (Legal Business Name): BRIAN MICHAEL STEFFEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 29TH ST NE
CEDAR RAPIDS IA
52402-3452
US

IV. Provider business mailing address

7001 SURREY DR NE
CEDAR RAPIDS IA
52402-1409
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-6994
  • Fax: 319-368-3399
Mailing address:
  • Phone: 319-377-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2873
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier27532
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK
# 2
Identifier0241513
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: