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General NPI Number Information
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NPI Number | 1083898696
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Entity Type | Organization
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Legal Business Name | STEPPING STONE CLINIC
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 9070 58TH DR E
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City | BRADENTON
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State | FL
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Zip | 34202-6110
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Country | US
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Telephone | 941-758-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 9070 58TH DRIVE EAST
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City | BRADENTON
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State | FL
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Zip | 34202
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Country | US
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Telephone | 941-758-1111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA SUE WALD
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Credential |
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Telephone | 941-758-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 10982
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License Number State | FL
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