Provider Demographics
NPI:1578221909
Name:STEEN, JESSE NASH (LMT)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:NASH
Last Name:STEEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 LIBBY ST APT A
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4832
Mailing Address - Country:US
Mailing Address - Phone:229-205-0315
Mailing Address - Fax:
Practice Address - Street 1:1603 LIBBY ST APT A
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4832
Practice Address - Country:US
Practice Address - Phone:229-205-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty