1669178711 NPI number — STEPPING STONES DAY HABLITATION, LLC

Table of content: DR. JARED SUNDVISSON AELONY DPM (NPI 1932125697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669178711 NPI number — STEPPING STONES DAY HABLITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPPING STONES DAY HABLITATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669178711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9714 KNOB OAK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78250-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5545 NW LOOP 410 STE 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78238-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-726-4440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MUCKLEROY
Authorized Official First Name:
MARC
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
210-386-8277

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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