Healthcare Provider Details

I. General information

NPI: 1104818558
Provider Name (Legal Business Name): HUPPERT PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 S. GILBERT ROAD STE. 1-609
CHANDLER AZ
85249-6021
US

IV. Provider business mailing address

4960 S. GILBERT ROAD STE. 1-609
CHANDLER AZ
85249-6021
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-7779
  • Fax: 480-821-6820
Mailing address:
  • Phone: 480-821-7779
  • Fax: 480-821-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LEO WILLIAM HUPPERT III
Title or Position: BUSINESS MGR/CO OWNER
Credential:
Phone: 480-821-7779