Provider Demographics
NPI:1912073875
Name:STEP UP PHYSICAL THERAPY & REHABILITATION, INC
Entity Type:Organization
Organization Name:STEP UP PHYSICAL THERAPY & REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MALVAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:941-423-7705
Mailing Address - Street 1:14866 TAMIAMI TRAIL
Mailing Address - Street 2:SUITE A204
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287
Mailing Address - Country:US
Mailing Address - Phone:941-423-7705
Mailing Address - Fax:941-423-7712
Practice Address - Street 1:14866 TAMIAMI TRAIL
Practice Address - Street 2:SUITE A204
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287
Practice Address - Country:US
Practice Address - Phone:941-423-7705
Practice Address - Fax:941-423-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY052QOtherBCBS
FLK5957Medicare PIN