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General NPI Number Information
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NPI Number | 1013142884
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Entity Type | Individual
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Provider Name | STEVE MIDDLETON PT, DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 100 S GLENVIEW DR
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City | CARBONDALE
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State | IL
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Zip | 62901-2238
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Country | US
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Telephone | 618-559-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 312 E 5TH ST
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City | FULTON
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State | MO
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Zip | 65251-1719
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Country | US
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Telephone | 618-559-8196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2018003451
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2015028965
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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