Provider Demographics
NPI:1225322498
Name:MYLESTONES PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:MYLESTONES PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNERS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO CAVAZOS
Authorized Official - Middle Name:AND
Authorized Official - Last Name:WENDY T. STENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-735-6978
Mailing Address - Street 1:4522 FREDERICKSBURG RD
Mailing Address - Street 2:STE. A-45
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-6521
Mailing Address - Country:US
Mailing Address - Phone:210-735-7968
Mailing Address - Fax:210-735-7969
Practice Address - Street 1:4522 FREDERICKSBURG RD
Practice Address - Street 2:STE. A-45
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-6521
Practice Address - Country:US
Practice Address - Phone:210-735-7968
Practice Address - Fax:210-735-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109927225X00000X
TX104661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty