Healthcare Provider Details

I. General information

NPI: 1639680945
Provider Name (Legal Business Name): TRANSITIONAL STEPS PEDIATRIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 E CHATHAM ST STE 300
CARY NC
27511-3372
US

IV. Provider business mailing address

167 E CHATHAM ST STE 300
CARY NC
27511-3372
US

V. Phone/Fax

Practice location:
  • Phone: 919-973-8827
  • Fax: 919-981-8075
Mailing address:
  • Phone: 919-973-8827
  • Fax: 919-981-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP11704
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACIE JOHNSON
Title or Position: PRESIDENT
Credential: MPT
Phone: 919-973-8827