Healthcare Provider Details

I. General information

NPI: 1477986933
Provider Name (Legal Business Name): JUMPING STEP BY STEP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 SW 24TH ST STE 205
MIAMI FL
33155-2305
US

IV. Provider business mailing address

8415 SW 24TH ST STE 205
MIAMI FL
33155-2305
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6868
  • Fax: 305-262-6867
Mailing address:
  • Phone: 305-262-6868
  • Fax: 305-262-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 20342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 12235
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT13650
License Number StateFL

VIII. Authorized Official

Name: MS. PATRICIA G MCCUBBIN
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 305-588-0812