Provider Demographics
NPI:1598997074
Name:VANSTEENBERGH, BRIAN (MT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:VANSTEENBERGH
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 4092
Mailing Address - Street 2:116 N WINTER ST
Mailing Address - City:MIDWAY
Mailing Address - State:KY
Mailing Address - Zip Code:40347
Mailing Address - Country:US
Mailing Address - Phone:859-846-4039
Mailing Address - Fax:
Practice Address - Street 1:116 N WINTER ST
Practice Address - Street 2:.BOX 4092
Practice Address - City:MIDWAY
Practice Address - State:KY
Practice Address - Zip Code:40347
Practice Address - Country:US
Practice Address - Phone:859-846-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0365172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist