Provider Demographics
NPI:1750694006
Name:BUILDING BLOCKS PEDIATRIC PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:BUILDING BLOCKS PEDIATRIC PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TAMMINGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DHS, PCS
Authorized Official - Phone:608-289-9797
Mailing Address - Street 1:838 E AZALEA TER
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1606
Mailing Address - Country:US
Mailing Address - Phone:608-289-9797
Mailing Address - Fax:608-365-6933
Practice Address - Street 1:302 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4114
Practice Address - Country:US
Practice Address - Phone:608-289-9797
Practice Address - Fax:608-365-6933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty