Provider Demographics
NPI:1780913798
Name:STEP UP PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:STEP UP PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DEINES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-909-9393
Mailing Address - Street 1:8033 S RACE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3217
Mailing Address - Country:US
Mailing Address - Phone:303-909-9393
Mailing Address - Fax:303-738-5544
Practice Address - Street 1:8033 S RACE WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3217
Practice Address - Country:US
Practice Address - Phone:303-909-9393
Practice Address - Fax:303-738-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB5047Medicare PIN