Healthcare Provider Details

I. General information

NPI: 1417098195
Provider Name (Legal Business Name): STEVEN ROBERT HUTH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4964 BENCHMARK CENTRE DR
SWANSEA IL
62226-2028
US

IV. Provider business mailing address

326 N MAIN ST
BREESE IL
62230-1525
US

V. Phone/Fax

Practice location:
  • Phone: 618-632-5800
  • Fax:
Mailing address:
  • Phone: 618-541-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: