Provider Demographics
NPI:1699858613
Name:DELONG, STEVE R (MS ATC)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:R
Last Name:DELONG
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E BOONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99258-1774
Mailing Address - Country:US
Mailing Address - Phone:509-323-4205
Mailing Address - Fax:509-323-5789
Practice Address - Street 1:502 E BOONE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99258-1774
Practice Address - Country:US
Practice Address - Phone:509-323-4205
Practice Address - Fax:509-323-5789
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer