Provider Demographics
NPI:1154441244
Name:SGM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SGM PHYSICAL THERAPY
Other - Org Name:STEVE METTERNICH PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:METTERNICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-236-5952
Mailing Address - Street 1:513 CONESTOGA CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-4218
Mailing Address - Country:US
Mailing Address - Phone:812-236-5952
Mailing Address - Fax:
Practice Address - Street 1:410 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1010
Practice Address - Country:US
Practice Address - Phone:217-826-2365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDF8520OtherRAILROAD MEDICARE GROUP
ILDF1743OtherRAILROAD MEDICARE
IL0001283001OtherBCBS GROUP NUMBER
IL1154441244OtherBLUE CROSS GROUP NPI#
IL344443227001Medicaid
IL=========OtherNEW TAX ID#
IL1154441244OtherBLUE CROSS GROUP NPI#
IL0001283001OtherBCBS GROUP NUMBER
IL344443227001Medicaid
IL202039Medicare PIN