Healthcare Provider Details

I. General information

NPI: 1366596702
Provider Name (Legal Business Name): SMALL STEPS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N MAIN STREET
TROY GROVE IL
61372
US

IV. Provider business mailing address

208 N MAIN STREET
TROY GROVE IL
61372
US

V. Phone/Fax

Practice location:
  • Phone: 815-538-5137
  • Fax: 815-538-5137
Mailing address:
  • Phone: 815-538-5137
  • Fax: 815-538-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: KRISTINA JULIE KOCH
Title or Position: OWNER
Credential: P.T.
Phone: 815-538-5137