Provider Demographics
NPI:1437979283
Name:STEPPING STONE PEDIATRIC PT, LLC
Entity type:Organization
Organization Name:STEPPING STONE PEDIATRIC PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RHUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:919-672-6543
Mailing Address - Street 1:2310 SPRUNT AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3116
Mailing Address - Country:US
Mailing Address - Phone:919-672-6543
Mailing Address - Fax:
Practice Address - Street 1:2310 SPRUNT AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3116
Practice Address - Country:US
Practice Address - Phone:919-672-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty