Healthcare Provider Details

I. General information

NPI: 1023381472
Provider Name (Legal Business Name): SMALL STEPS PEDIATRIC THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 W EMERALD ST
BOISE ID
83704
US

IV. Provider business mailing address

6180 W EMERALD ST
BOISE ID
83704
US

V. Phone/Fax

Practice location:
  • Phone: 208-629-8927
  • Fax: 208-629-7922
Mailing address:
  • Phone: 208-629-8927
  • Fax: 208-629-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-2559
License Number StateID

VIII. Authorized Official

Name: KEVIN SPIEGEL
Title or Position: MEMBER-OWNER
Credential: DPT
Phone: 208-629-8927