Provider Demographics
NPI:1417098195
Name:HUTH, STEVEN ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROBERT
Last Name:HUTH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1525
Mailing Address - Country:US
Mailing Address - Phone:618-541-0877
Mailing Address - Fax:
Practice Address - Street 1:4964 BENCHMARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2028
Practice Address - Country:US
Practice Address - Phone:618-632-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
38240375OtherBCBSIL
ILK38085Medicare PIN