Healthcare Provider Details

I. General information

NPI: 1326331067
Provider Name (Legal Business Name): TIM STEINHAUS MS, ATC/L, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8229 CLAYTON RD 204
SAINT LOUIS MO
63117-1155
US

IV. Provider business mailing address

8229 CLAYTON RD 204
SAINT LOUIS MO
63117-1155
US

V. Phone/Fax

Practice location:
  • Phone: 314-721-7325
  • Fax: 314-721-1157
Mailing address:
  • Phone: 314-721-7325
  • Fax: 314-721-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number123380
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2001008723
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096002847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: