Healthcare Provider Details

I. General information

NPI: 1528727732
Provider Name (Legal Business Name): JUST PEACHY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 LADEAN CT STE E
SIMPSONVILLE SC
29680-7504
US

IV. Provider business mailing address

222 LADEAN CT STE E
SIMPSONVILLE SC
29680-7504
US

V. Phone/Fax

Practice location:
  • Phone: 864-399-6423
  • Fax:
Mailing address:
  • Phone: 864-399-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LISA HEATON
Title or Position: OWNER
Credential:
Phone: 864-320-1973