Healthcare Provider Details

I. General information

NPI: 1457327207
Provider Name (Legal Business Name): JEFFERY LEE STEIN ATC, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N MARTIN JISCHKE DR WELLNESS SUITE - PT
WEST LAFAYETTE IN
47907-2030
US

IV. Provider business mailing address

355 N MARTIN JISCHKE DR WELLNESS SUITE - PT
WEST LAFAYETTE IN
47907-2030
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-1839
  • Fax: 765-496-0079
Mailing address:
  • Phone: 765-494-1839
  • Fax: 765-496-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007539A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3600945A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-019026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: