Provider Demographics
NPI:1578172656
Name:STEINKE, MADALYN MAY
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:MAY
Last Name:STEINKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:MAY
Other - Last Name:SMOKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13700 N 700 W
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-8755
Mailing Address - Country:US
Mailing Address - Phone:219-798-9670
Mailing Address - Fax:
Practice Address - Street 1:11055 BROADWAY STE E
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7300
Practice Address - Country:US
Practice Address - Phone:219-798-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013786A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist