Healthcare Provider Details

I. General information

NPI: 1972732949
Provider Name (Legal Business Name): HANDPRINTS AND FOOTSTEPS PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 LORD ANSON DR
WAXHAW NC
28173-6808
US

IV. Provider business mailing address

7917 FAWNWOOD LN
TEGA CAY SC
29708-8221
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-8593
  • Fax: 704-626-6614
Mailing address:
  • Phone: 803-802-8593
  • Fax: 704-626-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SEAY
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 803-370-1593