Healthcare Provider Details

I. General information

NPI: 1639217409
Provider Name (Legal Business Name): EARLY STEPS PROGRAM - EARLY STEPS PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12 AVE MAILMAN CENTER FOR CHILD DEVELOPMENT (D820)
MIAMI FL
33136
US

IV. Provider business mailing address

1601 NW 12 AVE MAILMAN CENTER FOR CHILD DEVELOPMENT (D820)
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6660
  • Fax: 305-243-3501
Mailing address:
  • Phone: 305-243-6660
  • Fax: 305-243-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES R. BAUER
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 305-243-6660