MEDICARE: STEPPIN UP PHYSICAL THERAPY, INC.

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	225X00000X	Occupational Therapist		IN
2	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD3722	OTHER	IN	MEDICARE RAILRAOD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043296510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPPIN UP PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	12844 COLDWATER RD STE B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8833
Country	:	US
Telephone Number	:	260-497-7191
Fax Number	:	260-744-5586

Provider Business Practice Location Address
First Line	:	9823 AUBURN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2347
Country	:	US
Telephone Number	:	260-497-7191
Fax Number	:	260-497-7791

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON D HAZELETT
Credential	:	DPT
Telephone Number	:	260-497-7191

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	06/07/2023

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