Healthcare Provider Details

I. General information

NPI: 1659003549
Provider Name (Legal Business Name): THE BABY PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 WOODLAKE LN
ALEXANDRIA VA
22315-2638
US

IV. Provider business mailing address

6011 WOODLAKE LN
ALEXANDRIA VA
22315-2638
US

V. Phone/Fax

Practice location:
  • Phone: 860-287-0570
  • Fax:
Mailing address:
  • Phone: 860-287-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: ALLISON KOPS
Title or Position: OWNER/CLINICIAN
Credential: DPT
Phone: 860-287-0570