Provider Demographics
NPI:1760488258
Name:CHENOWETH, STEVEN T (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:CHENOWETH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1975
Mailing Address - Country:US
Mailing Address - Phone:904-432-7558
Mailing Address - Fax:866-858-7371
Practice Address - Street 1:308 1/2 CENTRE ST OFC 2
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4241
Practice Address - Country:US
Practice Address - Phone:904-432-7558
Practice Address - Fax:866-858-7371
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003663225100000X
FLPT 13398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000786508AMedicaid
GA000786508GMedicaid
GA000786508FMedicaid
FL887934600Medicaid
GA000786508LMedicaid
GA000786508KMedicaid
GA000786508MMedicaid
GAP00319893OtherRR MEDICARE
GA000786508HMedicaid
FLP00367613OtherRR MEDICARE
GA000786508LMedicaid