Basic Information
| Provider Information | |||||||||
| NPI: | 1154685162 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BABAR ENTERPRISES LLC | ||||||||
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| OtherOrganizationName: | EXCEL SPORTS & PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2454 W CLAY ST | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633012548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369164625 | ||||||||
| FaxNumber: | 6369164625 | ||||||||
| Practice Location | |||||||||
| Address1: | 1346 CLARKSON CLAYTON CTR | ||||||||
| Address2: | |||||||||
| City: | ELLISVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630112145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362275200 | ||||||||
| FaxNumber: | 6362275202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 04/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | DAVIDSON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6363565000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.