Provider Demographics
NPI:1790437226
Name:STEPPING FORWARD THERAPY LLC
Entity Type:Organization
Organization Name:STEPPING FORWARD THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:LICEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-479-5537
Mailing Address - Street 1:8065 SW 107TH AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4880
Mailing Address - Country:US
Mailing Address - Phone:786-479-5537
Mailing Address - Fax:
Practice Address - Street 1:8065 SW 107TH AVE APT 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4880
Practice Address - Country:US
Practice Address - Phone:786-479-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty