Provider Demographics
NPI:1124562087
Name:KIDABILITY, INC.
Entity Type:Organization
Organization Name:KIDABILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:POULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-579-1699
Mailing Address - Street 1:2854 MITCHELL PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4258
Mailing Address - Country:US
Mailing Address - Phone:404-579-1699
Mailing Address - Fax:404-759-2166
Practice Address - Street 1:2854 MITCHELL PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4258
Practice Address - Country:US
Practice Address - Phone:404-579-1699
Practice Address - Fax:404-759-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy