1104818558 NPI number — HUPPERT PEDIATRIC THERAPY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104818558 NPI number — HUPPERT PEDIATRIC THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUPPERT PEDIATRIC THERAPY, INC.
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:
Provider Other Organization Name Type Code:
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:
1104818558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 S. GILBERT ROAD
Provider Second Line Business Mailing Address:
STE. 1-609
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85249-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-821-7779
Provider Business Mailing Address Fax Number:
480-821-6820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4960 S. GILBERT ROAD
Provider Second Line Business Practice Location Address:
STE. 1-609
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85249-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-821-7779
Provider Business Practice Location Address Fax Number:
480-821-6820
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUPPERT
Authorized Official First Name:
LEO
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
BUSINESS MGR/CO OWNER
Authorized Official Telephone Number:
480-821-7779

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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