Provider Demographics
NPI:1487666897
Name:VINSON, STEVEN MORRIS (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MORRIS
Last Name:VINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 NE LOOP 410
Mailing Address - Street 2:#100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5212
Mailing Address - Country:US
Mailing Address - Phone:210-805-9595
Mailing Address - Fax:210-829-9595
Practice Address - Street 1:1779 NE LOOP 410
Practice Address - Street 2:#100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5212
Practice Address - Country:US
Practice Address - Phone:210-805-9595
Practice Address - Fax:210-829-9595
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80807TOtherBCBS
TX80807TOtherBCBS