Provider Demographics
NPI:1669602256
Name:BASTIAN, STEVEN MERRILL (DPT)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MERRILL
Last Name:BASTIAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1906 FAIRVIEW AVE
Mailing Address - Street 2:STE 410
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-5407
Mailing Address - Country:US
Mailing Address - Phone:208-454-9839
Mailing Address - Fax:208-454-0727
Practice Address - Street 1:130 S MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2601
Practice Address - Country:US
Practice Address - Phone:208-461-5057
Practice Address - Fax:208-461-5210
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2016-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ID2932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1652956Medicare PIN