Healthcare Provider Details

I. General information

NPI: 1497727960
Provider Name (Legal Business Name): BARRIE EUGENE STEELE MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 KIBBIE ACTIVITY CENTER
MOSCOW ID
83844-2302
US

IV. Provider business mailing address

519 N GRANT ST
MOSCOW ID
83843
US

V. Phone/Fax

Practice location:
  • Phone: 208-885-0212
  • Fax:
Mailing address:
  • Phone: 208-883-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR-028
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: