Healthcare Provider Details

I. General information

NPI: 1639166036
Provider Name (Legal Business Name): SHANE M STEELE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIN ST
GREENVILLE PA
16125-2129
US

IV. Provider business mailing address

PO BOX 66
CANFIELD OH
44406-0066
US

V. Phone/Fax

Practice location:
  • Phone: 724-588-2870
  • Fax: 724-588-2890
Mailing address:
  • Phone: 330-759-2603
  • Fax: 330-759-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017072
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: