MEDICARE: EARLY STRIDES THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1629837596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY STRIDES THERAPY LLC

Provider Business Mailing Address
First Line	:	2324 E 74TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6626
Country	:	US
Telephone Number	:	917-443-3199
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 E 74TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6626
Country	:	US
Telephone Number	:	917-443-3199
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. JULIA YAKUBOV
Credential	:	MSPT
Telephone Number	:	917-443-3199

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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Directions to “EARLY STRIDES THERAPY LLC ” Practice Location

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