Provider Demographics
NPI:1558687137
Name:BABY STEPS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BABY STEPS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:201-857-4425
Mailing Address - Street 1:18 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1530
Mailing Address - Country:US
Mailing Address - Phone:201-857-4425
Mailing Address - Fax:801-336-9639
Practice Address - Street 1:18 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1530
Practice Address - Country:US
Practice Address - Phone:201-857-4425
Practice Address - Fax:801-336-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00907400261QP2000X
NJ40QA00926400261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090940Medicare PIN