Provider Demographics
NPI:1043529217
Name:KIDS UNLIMITED THERAPY FUN AND FITNESS CENTER, P.C.
Entity Type:Organization
Organization Name:KIDS UNLIMITED THERAPY FUN AND FITNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:TREME
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:409-554-4616
Mailing Address - Street 1:6755 PHELAN BLVD
Mailing Address - Street 2:SUITE 38
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6075
Mailing Address - Country:US
Mailing Address - Phone:409-554-4616
Mailing Address - Fax:409-554-4617
Practice Address - Street 1:6755 PHELAN BLVD
Practice Address - Street 2:SUITE 38
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6075
Practice Address - Country:US
Practice Address - Phone:409-554-4616
Practice Address - Fax:409-554-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181418801Medicaid