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General NPI Number Information
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NPI Number | 1114257474
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Entity Type | Organization
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Legal Business Name | ONE STEP AHEAD PEDIATRIC PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/10/2010
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Last Update Date | 01/10/2010
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Provider Practice Location Address
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Address Line | 150 SIERRA ST
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City | EL SEGUNDO
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State | CA
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Zip | 90245-4117
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Country | US
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Telephone | 310-890-7584
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Fax | 310-642-1195
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Provider Business Mailing Address
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Address Line | 6962 W 85TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90045-2603
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Country | US
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Telephone | 310-890-7584
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Fax | 310-642-1195
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Authorized Official
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Title or Position | CEO/PHYSICAL TEHRAPIST
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Name | MRS. LISA BRADFORD ULRICH
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Credential | PT
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Telephone | 310-890-7584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT25103
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License Number State | CA
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