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General NPI Number Information
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NPI Number | 1306981824
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Entity Type | Organization
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Legal Business Name | STEP UP PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1750 HIGHWAY 160 W SUITE 101-175
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City | FORT MILL
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State | SC
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Zip | 29708-8009
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Country | US
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Telephone | 803-981-4054
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Fax | 803-802-2264
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Provider Business Mailing Address
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Address Line | 1750 HIGHWAY 160 W SUITE 101-175
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City | FORT MILL
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State | SC
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Zip | 29708-8009
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Country | US
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Telephone | 803-981-4054
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Fax | 803-802-2264
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEBORAH J ROEN
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Credential | PT
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Telephone | 803-981-4054
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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 |
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License Number State |
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