Provider Demographics
NPI:1942716774
Name:MEINERT, STEVEN MARC (DPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARC
Last Name:MEINERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4431
Mailing Address - Country:US
Mailing Address - Phone:209-522-2673
Mailing Address - Fax:209-522-2955
Practice Address - Street 1:122 W GRANGER AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4431
Practice Address - Country:US
Practice Address - Phone:209-522-2673
Practice Address - Fax:209-522-2955
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist