Basic Information
| Provider Information | |||||||||
| NPI: | 1558426825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPPING UP PEDIATRIC PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 W COUNTRY RANCH DR | ||||||||
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| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205919929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2238 E GINTER RD | ||||||||
| Address2: | SUNNYSIDE UNIFIED SCHOOL DISTRICT #12 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205452137 | ||||||||
| FaxNumber: | 5205452120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 02/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | CURCIO | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5205919929 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4231 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 496712 | 05 | AZ | MEDICAID |