Provider Demographics
NPI:1194910596
Name:STRATTON, STEVEN LEO (MHS, PT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEO
Last Name:STRATTON
Suffix:
Gender:M
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 OAK INDUSTRIAL DR NE STE 208
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-6037
Mailing Address - Country:US
Mailing Address - Phone:616-292-6736
Mailing Address - Fax:
Practice Address - Street 1:2215 OAK INDUSTRIAL DR NE STE 208
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6037
Practice Address - Country:US
Practice Address - Phone:616-292-6736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D15740OtherBLUE CROSS/BLUE SHIELD
MI0D15740OtherBLUE CROSS/BLUE SHIELD