1053573634 NPI number — KIDSPOT PHYSICAL THERAPY LLC

Table of content: (NPI 1053573634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053573634 NPI number — KIDSPOT PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDSPOT PHYSICAL THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDSPOT PEDIATRIC THERAPIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053573634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 MCCASLIN BLVD.
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-604-6441
Provider Business Mailing Address Fax Number:
303-957-1955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 MCCASLIN BLVD.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-604-6441
Provider Business Practice Location Address Fax Number:
303-957-1955
Provider Enumeration Date:
06/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FUENTES
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER, OWNER, PT
Authorized Official Telephone Number:
303-604-6441

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 99978245 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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