1336367614 NPI number — KIDS N MOTION PHYSICAL THERAPY LLC

Table of content: (NPI 1336367614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336367614 NPI number — KIDS N MOTION PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS N MOTION 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:
Provider Other Organization Name Type Code:
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:
1336367614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDNEYVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28727-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-692-9944
Provider Business Mailing Address Fax Number:
828-692-9945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2560 CHIMNEY ROCK RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28792-8108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-692-9944
Provider Business Practice Location Address Fax Number:
828-692-9945
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-692-9944

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  2868 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06777 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7212101 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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