Provider Demographics
NPI:1366596702
Name:SMALL STEPS, INC
Entity type:Organization
Organization Name:SMALL STEPS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:JULIE
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-538-5137
Mailing Address - Street 1:208 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TROY GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61372
Mailing Address - Country:US
Mailing Address - Phone:815-538-5137
Mailing Address - Fax:815-538-5137
Practice Address - Street 1:208 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:TROY GROVE
Practice Address - State:IL
Practice Address - Zip Code:61372
Practice Address - Country:US
Practice Address - Phone:815-538-5137
Practice Address - Fax:815-538-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11445116OtherCAQH PROVIDER ID
IL0005032019OtherBCBS #