Provider Demographics
NPI:1174342778
Name:GREVE, STEVEN WAYNE
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:GREVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-0141
Mailing Address - Country:US
Mailing Address - Phone:970-343-0347
Mailing Address - Fax:
Practice Address - Street 1:250 TANAGER CIR # X6422
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-6496
Practice Address - Country:US
Practice Address - Phone:970-343-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1418225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty