=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801176284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURE STEP PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2011
-----------------------------------------------------
Last Update Date | 09/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7101 NARROWS AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11209-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-921-7031
-----------------------------------------------------
Fax | 718-921-1040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7101 NARROWS AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11209-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-921-7031
-----------------------------------------------------
Fax | 718-921-1040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MRS. MARY ANN COUGHLIN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 718-921-7031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 6708
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------