=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225918279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEADY STRIDES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2025
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3394 LAKE ELMO AVE N
-----------------------------------------------------
City | LAKE ELMO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55042-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-900-5629
-----------------------------------------------------
Fax | 651-705-7002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2327 MORGAN AVE N
-----------------------------------------------------
City | WEST LAKELAND
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55082-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-900-5629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACTOR
-----------------------------------------------------
Name | MS. PEG KINDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-306-8499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------