Healthcare Provider Details

I. General information

NPI: 1649753534
Provider Name (Legal Business Name): STEP IT UP DANCE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 N 59TH AVE STE 9
GLENDALE AZ
85301-6763
US

IV. Provider business mailing address

6914 W COLTER ST
GLENDALE AZ
85303-5819
US

V. Phone/Fax

Practice location:
  • Phone: 623-235-1446
  • Fax:
Mailing address:
  • Phone: 623-235-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number611885971
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number611885971
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number611885971
License Number StateAZ

VIII. Authorized Official

Name: JAMIE KLINGINSMITH
Title or Position: OWNER
Credential:
Phone: 623-235-1446