Provider Demographics
NPI:1073892600
Name:PT FOR KIDS, LLC
Entity Type:Organization
Organization Name:PT FOR KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:509-521-9080
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:WA
Mailing Address - Zip Code:99343-0366
Mailing Address - Country:US
Mailing Address - Phone:509-521-9080
Mailing Address - Fax:
Practice Address - Street 1:4206 W 24TH AVE
Practice Address - Street 2:B104
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2321
Practice Address - Country:US
Practice Address - Phone:509-521-9080
Practice Address - Fax:866-844-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-13
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty