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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1215005624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPPIN UP PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	5800 FAIRFIELD AVE STE 150
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-3450
Country	:	US
Telephone Number	:	260-744-5585
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	:	260-744-5586

Authorized Official
Title or Position	:	MPT
Name	:	JASON HAZELETT
Credential	:
Telephone Number	:	260-744-5585

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	03/15/2023

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