1023220449 NPI number — MRS. SANDRA DENISE STEELE P.T.

Table of content: MRS. SANDRA DENISE STEELE P.T. (NPI 1023220449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023220449 NPI number — MRS. SANDRA DENISE STEELE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEELE
Provider First Name:
SANDRA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEELE
Provider Other First Name:
SANDRA
Provider Other Middle Name:
SHIRLEY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023220449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6096 HAGARS GROVE PASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37076-5603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-516-8822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 W BADDOUR PKWY STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37087-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-453-1422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2257 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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