Provider Demographics
NPI:1306019369
Name:DECKER, STEPHEN GREGG (MPT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GREGG
Last Name:DECKER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 GARFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3247
Mailing Address - Country:US
Mailing Address - Phone:304-865-6778
Mailing Address - Fax:304-865-7400
Practice Address - Street 1:5479 POTTSVILLE PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8650
Practice Address - Country:US
Practice Address - Phone:610-926-6778
Practice Address - Fax:610-926-7200
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9675225100000X
PAPT012314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025419330001Medicaid
NC149TTOtherBCBSNC
P00975709OtherRAILROAD MEDICARE
NC7212400Medicaid
P00975709OtherRAILROAD MEDICARE
NC7212400Medicaid