Basic Information
| Provider Information | |||||||||
| NPI: | 1376726117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEP INTO STRIDE P.T., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 433 77TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112093205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189218780 | ||||||||
| FaxNumber: | 7189218768 | ||||||||
| Practice Location | |||||||||
| Address1: | 6917 SHORE RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112091000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189218780 | ||||||||
| FaxNumber: | 7189218768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2007 | ||||||||
| LastUpdateDate: | 03/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | MABREY | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3474468579 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S.P.T | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 022939-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.