Provider Demographics
NPI:1033178827
Name:BABAR ENTERPRISES LLC
Entity Type:Organization
Organization Name:BABAR ENTERPRISES LLC
Other - Org Name:EXCEL SPORTS & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-356-5000
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:163-565-0000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:4800 MEXICO RD STE 104
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1666
Practice Address - Country:US
Practice Address - Phone:636-939-9540
Practice Address - Fax:636-939-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO118429OtherBLUE CROSS/BLUE SHIELD
MO7277952003OtherCIGNA
MODC3837OtherRAILROAD MEDICARE
MO384638OtherHEALTHLINK
MO118429OtherBLUE CROSS/BLUE SHIELD
MO=========001OtherTRICARE
MO384638OtherHEALTHLINK
MODC3837OtherRAILROAD MEDICARE
MO000014038Medicare PIN