Provider Demographics
NPI:1154842995
Name:KID PT LLC
Entity Type:Organization
Organization Name:KID PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:REDLICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, PCS
Authorized Official - Phone:908-543-4390
Mailing Address - Street 1:153 N ADAMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2742
Mailing Address - Country:US
Mailing Address - Phone:908-543-4390
Mailing Address - Fax:
Practice Address - Street 1:153 N ADAMSVILLE RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2742
Practice Address - Country:US
Practice Address - Phone:908-543-4390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-01
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty