Provider Demographics
NPI:1306981824
Name:STEP UP PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:STEP UP PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:803-981-4054
Mailing Address - Street 1:1750 HIGHWAY 160 W
Mailing Address - Street 2:SUITE 101-175
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8009
Mailing Address - Country:US
Mailing Address - Phone:803-981-4054
Mailing Address - Fax:803-802-2264
Practice Address - Street 1:1750 HIGHWAY 160 W
Practice Address - Street 2:SUITE 101-175
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8009
Practice Address - Country:US
Practice Address - Phone:803-981-4054
Practice Address - Fax:803-802-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty