Provider Demographics
NPI:1023722329
Name:DEEPER ROOTS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:DEEPER ROOTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-408-3290
Mailing Address - Street 1:2638 TABLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-8670
Mailing Address - Country:US
Mailing Address - Phone:310-408-3290
Mailing Address - Fax:866-655-2571
Practice Address - Street 1:4606 MOOREFIELD MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-9065
Practice Address - Country:US
Practice Address - Phone:310-408-3290
Practice Address - Fax:866-655-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty