Provider Demographics
NPI:1376862656
Name:JUMPSTART PEDIATRICS LLC
Entity Type:Organization
Organization Name:JUMPSTART PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RHYNO
Authorized Official - Middle Name:
Authorized Official - Last Name:COETSEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:803-361-6995
Mailing Address - Street 1:955 SAINT PETERS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8197
Mailing Address - Country:US
Mailing Address - Phone:803-361-6995
Mailing Address - Fax:
Practice Address - Street 1:955 SAINT PETERS CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8197
Practice Address - Country:US
Practice Address - Phone:803-361-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29402251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty