Provider Demographics
NPI:1063082667
Name:STEP UP PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:STEP UP PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-357-0505
Mailing Address - Street 1:2211 FORT ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4135
Mailing Address - Country:US
Mailing Address - Phone:734-357-0505
Mailing Address - Fax:734-357-0506
Practice Address - Street 1:15750 NORTHLINE RD STE B
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2378
Practice Address - Country:US
Practice Address - Phone:734-357-0505
Practice Address - Fax:734-357-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty