Provider Demographics
NPI:1649753534
Name:STEP IT UP DANCE THERAPY LLC
Entity Type:Organization
Organization Name:STEP IT UP DANCE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGINSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-235-1446
Mailing Address - Street 1:6914 W COLTER ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-5819
Mailing Address - Country:US
Mailing Address - Phone:623-235-1446
Mailing Address - Fax:
Practice Address - Street 1:5270 N 59TH AVE STE 9
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-6763
Practice Address - Country:US
Practice Address - Phone:623-235-1446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ611885971221700000X, 225600000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty