Healthcare Provider Details

I. General information

NPI: 1689642100
Provider Name (Legal Business Name): THOMAS L STEC PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25303-1263
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 304-744-2300
  • Fax: 304-744-8195
Mailing address:
  • Phone: 740-441-1949
  • Fax: 740-446-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number392
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: