Provider Demographics
NPI:1699718924
Name:STRAUB, STEVEN CHARLES (PT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CHARLES
Last Name:STRAUB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 STETTIN DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-845-8669
Mailing Address - Fax:
Practice Address - Street 1:1518 METRO DR
Practice Address - Street 2:STE 108
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476
Practice Address - Country:US
Practice Address - Phone:715-359-8465
Practice Address - Fax:715-359-8832
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5228024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI94868OtherSECURITY HEALTH
WI41810500Medicaid
WI41810500Medicaid