Provider Demographics
NPI:1720163306
Name:A STEP AHEAD PHYSICAL THERAPY P.A.
Entity Type:Organization
Organization Name:A STEP AHEAD PHYSICAL THERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORES
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:239-642-3948
Mailing Address - Street 1:601 ELKCAM CIR EAST
Mailing Address - Street 2:SUITE A2
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145
Mailing Address - Country:US
Mailing Address - Phone:239-642-3948
Mailing Address - Fax:239-642-4243
Practice Address - Street 1:601 ELKCAM CIR EAST
Practice Address - Street 2:SUITE A2-5
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145
Practice Address - Country:US
Practice Address - Phone:239-642-3948
Practice Address - Fax:239-642-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0014520225100000X
FLPT21538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6602Medicare UPIN