1669851275 NPI number — STEP THERAPY LLC

Table of content: (NPI 1669851275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669851275 NPI number — STEP THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEP THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC THERAPY INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669851275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6535 S DAYTON ST STE 1050
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-6134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-439-9100
Provider Business Mailing Address Fax Number:
855-283-4752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6535 SOUTH DAYTON STREET
Provider Second Line Business Practice Location Address:
STE 3800
Provider Business Practice Location Address City Name:
GREENWOODVILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
393-649-9007
Provider Business Practice Location Address Fax Number:
303-649-9008
Provider Enumeration Date:
05/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RUNKLE
Authorized Official First Name:
J
Authorized Official Middle Name:
MARIAH
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
720-439-9100

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  OT.0003573 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com