Provider Demographics
NPI:1457327207
Name:STEIN, JEFFERY LEE (ATC, DPT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:LEE
Last Name:STEIN
Suffix:
Gender:M
Credentials:ATC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 N MARTIN JISCHKE DR
Mailing Address - Street 2:WELLNESS SUITE - PT
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2030
Mailing Address - Country:US
Mailing Address - Phone:765-494-1839
Mailing Address - Fax:765-496-0079
Practice Address - Street 1:355 N MARTIN JISCHKE DR
Practice Address - Street 2:WELLNESS SUITE - PT
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2030
Practice Address - Country:US
Practice Address - Phone:765-494-1839
Practice Address - Fax:765-496-0079
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007539A225100000X
IN3600945A2255A2300X
IL070-019026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36000945AOtherAT LICENSE
IN05007539AOtherPT LICENSE