1912073875 NPI number — STEP UP PHYSICAL THERAPY & REHABILITATION, INC

Table of content: (NPI 1912073875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912073875 NPI number — STEP UP PHYSICAL THERAPY & REHABILITATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEP UP PHYSICAL THERAPY & REHABILITATION, 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:
1912073875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14866 TAMIAMI TRAIL
Provider Second Line Business Mailing Address:
SUITE A204
Provider Business Mailing Address City Name:
NORTH PORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-423-7705
Provider Business Mailing Address Fax Number:
941-423-7712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14866 TAMIAMI TRAIL
Provider Second Line Business Practice Location Address:
SUITE A204
Provider Business Practice Location Address City Name:
NORTH PORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-423-7705
Provider Business Practice Location Address Fax Number:
941-423-7712
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALVAS
Authorized Official First Name:
GERALDINE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
941-423-7705

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT10461 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y052Q . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com