Healthcare Provider Details

I. General information

NPI: 1548425002
Provider Name (Legal Business Name): BABAR ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E BOONESLICK RD SUITE 3
WARRENTON MO
63383-2127
US

IV. Provider business mailing address

2454 W CLAY ST
SAINT CHARLES MO
63301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-6350
  • Fax: 636-456-6084
Mailing address:
  • Phone: 636-916-4625
  • Fax: 636-916-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNO LICENSE REQUIRED
License Number StateMO

VIII. Authorized Official

Name: STEVEN N DAVIDSON
Title or Position: OWNER / AUTHORIZED OFFICIAL
Credential:
Phone: 616-356-5000