Healthcare Provider Details

I. General information

NPI: 1932624384
Provider Name (Legal Business Name): BOOST BABIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6718 LA CONCHA PASS
AUSTIN TX
78749-1716
US

IV. Provider business mailing address

6718 LA CONCHA PASS
AUSTIN TX
78749-1716
US

V. Phone/Fax

Practice location:
  • Phone: 512-809-1329
  • Fax:
Mailing address:
  • Phone: 512-809-1329
  • 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 Code251E00000X
TaxonomyHome Health Agency
License Number1238598
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1238598
License Number StateTX

VIII. Authorized Official

Name: CAROLYN ZUIKER
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT, DPT
Phone: 512-809-1329