Healthcare Provider Details

I. General information

NPI: 1255935441
Provider Name (Legal Business Name): STEP FORWARD WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALL ST SW STE 112E
GRAND RAPIDS MI
49503-6500
US

IV. Provider business mailing address

401 HALL ST SW STE 112E
GRAND RAPIDS MI
49503-6500
US

V. Phone/Fax

Practice location:
  • Phone: 734-646-4221
  • Fax:
Mailing address:
  • Phone: 734-646-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRANDON YUENGER
Title or Position: OWNER
Credential: PT, DPT, CIDN
Phone: 734-646-4221