MEDICARE: STEVEN RICHARD DIPAOLA P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3245	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102255327	OTHER		OWCP PROVIDER ID

General Provider Information

NPI Number	:	1164439071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN RICHARD DIPAOLA P.T.

Provider Business Mailing Address
First Line	:	4050 E COTTON CENTER BLVD STE 18
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-8862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 E COTTON CENTER BLVD STE 18
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-8862
Country	:	US
Telephone Number	:	303-859-7474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	01/05/2022

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