Provider Demographics
NPI:1871182345
Name:BABY STEPS, LLC
Entity Type:Organization
Organization Name:BABY STEPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DICICCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:980-585-9950
Mailing Address - Street 1:3254 PENDLETON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4708
Mailing Address - Country:US
Mailing Address - Phone:571-244-2220
Mailing Address - Fax:
Practice Address - Street 1:3254 PENDLETON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4708
Practice Address - Country:US
Practice Address - Phone:980-585-9950
Practice Address - Fax:704-981-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC125584330OtherINDIVIDUAL NPI 1