Provider Demographics
NPI:1588117055
Name:A STEP AHEAD PEDORTHICS & ORTHOTICS LLC
Entity type:Organization
Organization Name:A STEP AHEAD PEDORTHICS & ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPED CFO
Authorized Official - Phone:850-474-5003
Mailing Address - Street 1:2401 EXECUTIVE PLAZA RD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 EXECUTIVE PLAZA RD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8277
Practice Address - Country:US
Practice Address - Phone:850-474-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF234335E00000X
FLPED207335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier