Provider Demographics
NPI:1114192507
Name:STEGE, GARY ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:STEGE
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 1:310 W PATTON ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-1441
Mailing Address - Country:US
Mailing Address - Phone:217-493-2570
Mailing Address - Fax:
Practice Address - Street 1:1001 E PELLS ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-1300
Practice Address - Country:US
Practice Address - Phone:217-379-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010263314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility