Provider Demographics
NPI:1053367029
Name:POISSANT, STEVEN LLEWELLYN (PT,L, AC,CSCS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LLEWELLYN
Last Name:POISSANT
Suffix:
Gender:M
Credentials:PT,L, AC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:FERTILE
Mailing Address - State:MN
Mailing Address - Zip Code:56540-4328
Mailing Address - Country:US
Mailing Address - Phone:218-945-3409
Mailing Address - Fax:218-945-3588
Practice Address - Street 1:208 N MILL ST
Practice Address - Street 2:
Practice Address - City:FERTILE
Practice Address - State:MN
Practice Address - Zip Code:56540-4328
Practice Address - Country:US
Practice Address - Phone:218-945-3409
Practice Address - Fax:218-945-3588
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1080171100000X
MN3093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650000928Medicare ID - Type Unspecified