Healthcare Provider Details

I. General information

NPI: 1114257474
Provider Name (Legal Business Name): ONE STEP AHEAD PEDIATRIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2010
Last Update Date: 01/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SIERRA ST
EL SEGUNDO CA
90245-4117
US

IV. Provider business mailing address

6962 W 85TH ST
LOS ANGELES CA
90045-2603
US

V. Phone/Fax

Practice location:
  • Phone: 310-890-7584
  • Fax: 310-642-1195
Mailing address:
  • Phone: 310-890-7584
  • Fax: 310-642-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT25103
License Number StateCA

VIII. Authorized Official

Name: MRS. LISA BRADFORD ULRICH
Title or Position: CEO/PHYSICAL TEHRAPIST
Credential: PT
Phone: 310-890-7584