Provider Demographics
NPI:1831278571
Name:VENNE, STEPHEN LEO (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEO
Last Name:VENNE
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 1:2802 CASTLES GATE DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-7203
Mailing Address - Country:US
Mailing Address - Phone:712-266-0707
Mailing Address - Fax:
Practice Address - Street 1:2802 CASTLES GATE DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-7203
Practice Address - Country:US
Practice Address - Phone:712-266-0707
Practice Address - Fax:712-266-0709
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0290494Medicaid
IA43545OtherBC/BS
IA0290494Medicaid