=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952795247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEP SMART PHYSICAL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2015
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6129 TYNDALL AVE APT 3
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10471-1161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-329-5330
-----------------------------------------------------
Fax | 347-329-5332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6129 TYNDALL AVE APT 3
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10471-1161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 473-295-3303
-----------------------------------------------------
Fax | 347-329-5332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. JESSICA POLLACK
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 516-456-2175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 034327
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------