Provider Demographics
NPI:1194875500
Name:A STEP AHEAD PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:A STEP AHEAD PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREEMYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-998-6636
Mailing Address - Street 1:930 WOODSTOCK RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2220
Mailing Address - Country:US
Mailing Address - Phone:770-998-6636
Mailing Address - Fax:770-998-6646
Practice Address - Street 1:930 WOODSTOCK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2220
Practice Address - Country:US
Practice Address - Phone:770-998-6636
Practice Address - Fax:770-998-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT2661261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCKSMedicare PIN