Provider Demographics
NPI:1609635564
Name:SEIBEL, STEVEN JAMES (PTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAMES
Last Name:SEIBEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24828 N 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3313
Mailing Address - Country:US
Mailing Address - Phone:602-920-0976
Mailing Address - Fax:
Practice Address - Street 1:4022 E GREENWAY RD STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4798
Practice Address - Country:US
Practice Address - Phone:602-932-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0109562081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine