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General NPI Number Information
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NPI Number | 1861015083
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Entity Type | Organization
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Legal Business Name | EARLY STEPS THERAPY
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 5 JOHNSON SPRINGS RD
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City | MUNFORDVILLE
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State | KY
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Zip | 42765-9323
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Country | US
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Telephone | 270-537-3788
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Fax |
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Provider Business Mailing Address
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Address Line | 5 JOHNSON SPRINGS RD
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City | MUNFORDVILLE
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State | KY
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Zip | 42765-9323
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Country | US
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Telephone | 270-537-3788
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES CROLEY
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Credential |
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Telephone | 270-590-9942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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