Basic Information
Provider Information
NPI: 1902210867
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RONDE
FirstName: STEVEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CPO, LPO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2222 WELBORN ST
Address2:  
City: DALLAS
State: TX
PostalCode: 752193924
CountryCode: US
TelephoneNumber: 2145595000
FaxNumber: 2144437309
Practice Location
Address1: 2222 WELBORN ST
Address2:  
City: DALLAS
State: TX
PostalCode: 752193924
CountryCode: US
TelephoneNumber: 2145597440
FaxNumber: 2145597473
Other Information
ProviderEnumerationDate: 06/18/2014
LastUpdateDate: 02/11/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Z00000X89TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist 
224P00000X89TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist 

No ID Information.


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