Provider Demographics
NPI:1811047590
Name:STEELE, ROBIN LEE (PT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:STEELE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LEE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3166 NORTH OLD TRAIL
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-9409
Mailing Address - Country:US
Mailing Address - Phone:570-743-4333
Mailing Address - Fax:570-743-6012
Practice Address - Street 1:3166 NORTH OLD TRAIL
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9409
Practice Address - Country:US
Practice Address - Phone:570-743-4333
Practice Address - Fax:570-743-6012
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005256L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018875960001Medicaid
PAST1904774OtherBLUE SHIELD
PA50062516OtherBLUE CROSS
PAST1904774OtherBLUE SHIELD
107809R2TMedicare PIN