Steven Harry Coronado, PTA
Individual provider Active NPI Physical Therapy Assistant · Mauston, WI
NPI 1063948636 · NPPES record last updated May 2, 2017
Key facts
- NPI
- 1063948636
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2621-19 (WI)
- Practice address
- 610 McEvoy St
Mauston, WI 53948-1438 - Phone
- (608) 847-5100
- Fax
- (608) 847-5110
- NPI assigned
- May 2, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2621-19 | WI | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ptworks LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2621-19 | WI | Yes |
Addresses
Primary practice location
610 McEvoy St
Mauston, WI 53948-1438
Mailing address
610 McEvoy St
Mauston, WI 53948-1438
Phone (608) 847-5100
Other providers in Mauston, WI
- Tacy Camenga
- Kevin J Carrigan
- Jessica B Carroll
- Apanda Chumworachat
- Samantha R Clark
- Cristina Ann Custer
- Colleen Daines
- Margaret A. Dennison
- Theresa Dickmann
- Linda A. Diraimondo
All providers in Mauston, WI · Physical Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.