1598724577 NPI number — K.I.D.S. THERAPY ASSOCIATES, INC., A PHYSICAL THERAPY CORPORATION

Table of content: (NPI 1598724577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598724577 NPI number — K.I.D.S. THERAPY ASSOCIATES, INC., A PHYSICAL THERAPY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K.I.D.S. THERAPY ASSOCIATES, INC., A PHYSICAL THERAPY CORPORATION
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:
6
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:
1598724577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11838 BERNARDO PLAZA CT
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92128-2413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-673-5437
Provider Business Mailing Address Fax Number:
858-673-5434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11838 BERNARDO PLAZA CT
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-673-5437
Provider Business Practice Location Address Fax Number:
858-673-5434
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
TERRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT-PEDIATRICS DIVISION
Authorized Official Telephone Number:
303-437-4364

Provider Taxonomy Codes

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

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

  • Identifier: ZZZ09412Z . This is a "BLUE SHIELD SPEECH PIN #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ09413Z . This is a "BLUE SHIELD OT PIN #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ09414Z . This is a "BLUE SHIELD PT PIN #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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