Provider Demographics
NPI:1033376413
Name:A STEP AHEAD THERAPIES, LLC
Entity Type:Organization
Organization Name:A STEP AHEAD THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KGATALE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALATSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-414-4584
Mailing Address - Street 1:6013 BELLE ISLE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-1263
Mailing Address - Country:US
Mailing Address - Phone:260-414-4584
Mailing Address - Fax:260-492-6420
Practice Address - Street 1:6013 BELLE ISLE LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-1263
Practice Address - Country:US
Practice Address - Phone:260-414-4584
Practice Address - Fax:260-492-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001450A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty