Provider Demographics
NPI:1417314881
Name:STEP AHEAD THERAPY OF ROSEAU INC
Entity Type:Organization
Organization Name:STEP AHEAD THERAPY OF ROSEAU INC
Other - Org Name:STEP AHEAD THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-461-1121
Mailing Address - Street 1:27081 LOWER RICE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-4307
Mailing Address - Country:US
Mailing Address - Phone:218-461-1120
Mailing Address - Fax:219-461-1016
Practice Address - Street 1:506 LEXINGTON PKWY N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4644
Practice Address - Country:US
Practice Address - Phone:651-771-2012
Practice Address - Fax:651-771-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty