Provider Demographics
NPI:1043296510
Name:STEPPIN UP PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:STEPPIN UP PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAZELETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:260-497-7191
Mailing Address - Street 1:12844 COLDWATER RD STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8833
Mailing Address - Country:US
Mailing Address - Phone:260-497-7191
Mailing Address - Fax:260-744-5586
Practice Address - Street 1:9823 AUBURN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2347
Practice Address - Country:US
Practice Address - Phone:260-497-7191
Practice Address - Fax:260-497-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IN225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDD3722OtherMEDICARE RAILRAOD
IN200496360AMedicaid
INDD3722Medicare PIN