Provider Demographics
NPI:1407368160
Name:STEP GUARD, PLLC
Entity Type:Organization
Organization Name:STEP GUARD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:405-808-8128
Mailing Address - Street 1:20208 E 37TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1755
Mailing Address - Country:US
Mailing Address - Phone:405-808-8128
Mailing Address - Fax:
Practice Address - Street 1:20208 E 37TH ST S
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-1755
Practice Address - Country:US
Practice Address - Phone:405-808-8128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47452251X0800X, 261QA0900X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee