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General NPI Number Information
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NPI Number | 1750694006
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Entity Type | Organization
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Legal Business Name | BUILDING BLOCKS PEDIATRIC PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 302 W EXCHANGE ST
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City | FREEPORT
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State | IL
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Zip | 61032-4114
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Country | US
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Telephone | 608-289-9797
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Fax | 608-365-6933
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Provider Business Mailing Address
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Address Line | 838 E AZALEA TER
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City | BELOIT
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State | WI
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Zip | 53511-1606
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Country | US
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Telephone | 608-289-9797
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Fax | 608-365-6933
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANNA SUE TAMMINGA
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Credential | PT, DHS, PCS
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Telephone | 608-289-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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