Provider Demographics
NPI:1487891628
Name:STEINKE, DIANE ROSE (PT)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ROSE
Last Name:STEINKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 W NORTH AVE
Mailing Address - Street 2:#2W
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4423
Mailing Address - Country:US
Mailing Address - Phone:262-780-4300
Mailing Address - Fax:262-780-4301
Practice Address - Street 1:17000 W NORTH AVE
Practice Address - Street 2:#2W
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-780-4300
Practice Address - Fax:262-780-4301
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3323-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3323-024Medicaid