Provider Demographics
NPI:1376683219
Name:HARRAH, STEVEN DANIELL (PT,MTC,CHT)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DANIELL
Last Name:HARRAH
Suffix:
Gender:M
Credentials:PT,MTC,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:1340 E 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4508
Practice Address - Country:US
Practice Address - Phone:773-496-5147
Practice Address - Fax:872-215-9417
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-026532225100000X
FLPT11648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686709Medicare ID - Type UnspecifiedCLINIC MC PROVIDER NUMBER