Provider Demographics
NPI:1033577887
Name:DEHART, STEVE (ATC)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:DEHART
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROWLAND WAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5011
Mailing Address - Country:US
Mailing Address - Phone:415-328-1778
Mailing Address - Fax:
Practice Address - Street 1:625 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4499
Practice Address - Country:US
Practice Address - Phone:415-328-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS