Healthcare Provider Details

I. General information

NPI: 1831162650
Provider Name (Legal Business Name): STEVE JOHN MCCAULEY ATC, LAT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 LAS VEGAS BLVD S
LAS VEGAS NV
89109-1967
US

IV. Provider business mailing address

4840 ENGLEWOOD AVE
LAS VEGAS NV
89139-5776
US

V. Phone/Fax

Practice location:
  • Phone: 702-770-3752
  • Fax: 702-770-4920
Mailing address:
  • Phone: 702-218-9837
  • Fax: 702-770-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0506001
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: