Healthcare Provider Details

I. General information

NPI: 1063082667
Provider Name (Legal Business Name): STEP UP PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15750 NORTHLINE RD STE B
SOUTHGATE MI
48195-2378
US

IV. Provider business mailing address

2211 FORT ST
WYANDOTTE MI
48192-4135
US

V. Phone/Fax

Practice location:
  • Phone: 734-357-0505
  • Fax: 734-357-0506
Mailing address:
  • Phone: 734-357-0505
  • Fax: 734-357-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: FADI DELLY
Title or Position: OWNER
Credential: MD
Phone: 734-357-0505