Provider Demographics
NPI:1679638746
Name:STAAB, STEVEN MICHAEL (LAT, PES-NASM)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:STAAB
Suffix:
Gender:M
Credentials:LAT, PES-NASM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2012 CLIFF ALEX CT S UNIT D
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-2127
Mailing Address - Country:US
Mailing Address - Phone:262-391-9495
Mailing Address - Fax:
Practice Address - Street 1:100 N EAST AVE
Practice Address - Street 2:VAN MALE TRAINING ROOM
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3103
Practice Address - Country:US
Practice Address - Phone:262-524-7379
Practice Address - Fax:262-524-7376
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI631-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer