Provider Demographics
NPI:1235739442
Name:PYEVICH, STEVEN CURTIS
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CURTIS
Last Name:PYEVICH
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 1:1500 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-9400
Mailing Address - Country:US
Mailing Address - Phone:309-582-5108
Mailing Address - Fax:
Practice Address - Street 1:1500 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-9400
Practice Address - Country:US
Practice Address - Phone:309-582-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510398192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer