Provider Demographics
NPI:1164739074
Name:STEP BY STEP PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:STEP BY STEP PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:706-554-5700
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-0965
Mailing Address - Country:US
Mailing Address - Phone:706-554-5700
Mailing Address - Fax:706-554-5700
Practice Address - Street 1:506 SPRING BRANCH SPUR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-7505
Practice Address - Country:US
Practice Address - Phone:706-554-5700
Practice Address - Fax:706-554-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0073062251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA059782515BMedicaid