Provider Demographics
NPI:1275253015
Name:FUN ZONE KIDS THERAPY
Entity Type:Organization
Organization Name:FUN ZONE KIDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:716-464-0558
Mailing Address - Street 1:6424 MONTEGO CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5101
Mailing Address - Country:US
Mailing Address - Phone:716-464-0558
Mailing Address - Fax:
Practice Address - Street 1:6489 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2849
Practice Address - Country:US
Practice Address - Phone:716-464-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation