Provider Demographics
NPI:1053320895
Name:STEINBECK, LAWRENCE T (PT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:T
Last Name:STEINBECK
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 1:620 J L WHITE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4896
Mailing Address - Country:US
Mailing Address - Phone:706-692-9080
Mailing Address - Fax:706-692-1199
Practice Address - Street 1:620 J L WHITE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4896
Practice Address - Country:US
Practice Address - Phone:706-692-9080
Practice Address - Fax:706-692-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000965577BMedicaid
GA00965577AMedicaid
GA65BBBSRMedicare ID - Type UnspecifiedMEDICARE NUMBER