Basic Information
| Provider Information | |||||||||
| NPI: | 1184700684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEFFIE ENTERPRISES, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRO REHABILITATION SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1086 ROUTE 315 | ||||||||
| Address2: | |||||||||
| City: | PLAINS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708237761 | ||||||||
| FaxNumber: | 5708228033 | ||||||||
| Practice Location | |||||||||
| Address1: | 1086 ROUTE 315 | ||||||||
| Address2: | |||||||||
| City: | PLAINS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708237761 | ||||||||
| FaxNumber: | 5708228033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 02/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | CASSETORI | ||||||||
| AuthorizedOfficialFirstName: | DON | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MGR TREAS | ||||||||
| AuthorizedOfficialTelephone: | 5708237761 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 61915 | 01 | PA | GEISINGER | OTHER | 396759 | 01 | PA | CAPITAL BLUE CROSS BLUE S | OTHER | 338702 | 01 | PA | HEALTH AMERICA HEALTH ASS | OTHER | 614120 | 01 | PA | HIGHMARK BLUE CROSS BLUE | OTHER | 118707500 | 01 | PA | US DEPT OF LABOR | OTHER | 5234560 | 01 | PA | AETNA US HEALTHCARE | OTHER | 1020761450001 | 05 | PA | MEDICAID |