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General NPI Number Information
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NPI Number | 1104114412
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Entity Type | Organization
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Legal Business Name | FOOTSTEPS AND HANDPRINTS PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 3000 JOE DIMAGGIO BLVD SUITE 56
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City | ROUND ROCK
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State | TX
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Zip | 78665
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Country | US
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Telephone | 512-218-6955
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Fax | 512-367-5965
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Provider Business Mailing Address
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Address Line | 3000 JOE DIMAGGIO BLVD SUITE 56
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City | ROUND ROCK
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State | TX
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Zip | 78665
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Country | US
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Telephone | 512-218-6955
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Fax | 512-367-5965
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EMILY ONTIVEROS
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Credential | PT
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Telephone | 512-218-6955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1173628
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License Number State | TX
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