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General NPI Number Information
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NPI Number | 1033376413
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Entity Type | Organization
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Legal Business Name | A STEP AHEAD THERAPIES, LLC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 6013 BELLE ISLE LN
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City | FORT WAYNE
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State | IN
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Zip | 46835-1263
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Country | US
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Telephone | 260-414-4584
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Fax | 260-492-6420
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Provider Business Mailing Address
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Address Line | 6013 BELLE ISLE LN
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City | FORT WAYNE
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State | IN
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Zip | 46835-1263
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Country | US
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Telephone | 260-414-4584
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Fax | 260-492-6420
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Authorized Official
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Title or Position | MANAGER
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Name | MR. KGATALE S MALATSE
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Credential |
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Telephone | 260-414-4584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 31001450A
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License Number State | IN
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