Provider Demographics
NPI:1639516925
Name:VAN STEENBERGH, JASON MICHAEL (LMT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:VAN STEENBERGH
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 1:1598 SUMMERHILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5843
Mailing Address - Country:US
Mailing Address - Phone:859-608-6948
Mailing Address - Fax:
Practice Address - Street 1:1598 SUMMERHILL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-5843
Practice Address - Country:US
Practice Address - Phone:859-608-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-4102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist