Provider Demographics
NPI:1164531737
Name:STEIN, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 ASHLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6185
Mailing Address - Country:US
Mailing Address - Phone:770-772-4288
Mailing Address - Fax:
Practice Address - Street 1:565 LAKELAND PLZ
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2784
Practice Address - Country:US
Practice Address - Phone:770-889-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8047OtherLICENSE #