Provider Demographics
NPI:1003007659
Name:KIDS IN BALANCE, INC.
Entity Type:Organization
Organization Name:KIDS IN BALANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR./SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:813-677-8450
Mailing Address - Street 1:4507 COMPASS OAKS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7390
Mailing Address - Country:US
Mailing Address - Phone:813-677-8450
Mailing Address - Fax:813-677-5029
Practice Address - Street 1:10022 WATER WORKS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5301
Practice Address - Country:US
Practice Address - Phone:813-677-8450
Practice Address - Fax:813-677-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH21861251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA 5793OtherSPEECH-LANGUAGE PATHOLOGI
FLPT 23360OtherPHYSICAL THERAPY
FLOT 3546OtherOCCUPATIONAL THERAPIST