Provider Demographics
NPI:1932321148
Name:STEELE, MICHAEL (LMT PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STEELE
Suffix:
Gender:M
Credentials:LMT PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WYANDANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2231
Mailing Address - Country:US
Mailing Address - Phone:631-521-4918
Mailing Address - Fax:
Practice Address - Street 1:3075 VETERANS MEMORIAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7600
Practice Address - Country:US
Practice Address - Phone:631-805-2850
Practice Address - Fax:631-670-6475
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0012951225200000X
NY0069971225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant