MEDICARE: TINY TO MIGHTY PEDIATRIC THERAPY LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1952136087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINY TO MIGHTY PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	15825 S 46TH ST STE 128
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0445
Country	:	US
Telephone Number	:	480-330-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	15825 S 46TH ST STE 128
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-0445
Country	:	US
Telephone Number	:	480-330-0456
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MAURE SCHUHARDT
Credential	:	PT, DPT
Telephone Number	:	480-330-0456

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/13/2024

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Directions to “TINY TO MIGHTY PEDIATRIC THERAPY LLC ” Practice Location

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