Healthcare Provider Details

I. General information

NPI: 1093307548
Provider Name (Legal Business Name): KID STRIDES PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 NAVY PIER ST
PORTAGE MI
49002-8262
US

IV. Provider business mailing address

9880 NAVY PIER ST
PORTAGE MI
49002-8262
US

V. Phone/Fax

Practice location:
  • Phone: 269-779-3842
  • Fax:
Mailing address:
  • Phone: 269-779-3842
  • Fax:

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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA WESOLOWSKI
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 269-779-3842