Provider Demographics
NPI:1891475026
Name:STEP UP SPORTS MEDICINE PLLC
Entity type:Organization
Organization Name:STEP UP SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAGA SAI VENKATA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MADHAVAPEDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-668-3222
Mailing Address - Street 1:3020 CORPORATE CT STE 400
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5617
Mailing Address - Country:US
Mailing Address - Phone:817-668-3222
Mailing Address - Fax:
Practice Address - Street 1:3020 CORPORATE CT STE 400
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-5617
Practice Address - Country:US
Practice Address - Phone:817-668-3222
Practice Address - Fax:817-668-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty