=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578875514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A STEP AHEAD PHYSICAL THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2010
-----------------------------------------------------
Last Update Date | 07/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 INDIA STREET SUITE 2B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11222-1633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-738-2861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67 INDIA ST SUITE 2B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11222-1872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-738-2861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. JENNIFER A FRIEDLAND-STORA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 347-738-2861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 030431-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------