Provider Demographics
NPI:1558030098
Name:FIRST STEPS PEDIATRIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FIRST STEPS PEDIATRIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOENCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:218-591-8768
Mailing Address - Street 1:2210 DODDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2756
Mailing Address - Country:US
Mailing Address - Phone:218-591-8768
Mailing Address - Fax:
Practice Address - Street 1:2210 DODDRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2756
Practice Address - Country:US
Practice Address - Phone:218-591-8768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy