Provider Demographics
NPI:1386821619
Name:KIDS ON THE GO PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:KIDS ON THE GO PHYSICAL THERAPY INC.
Other - Org Name:KIDS ON THE GO THERAPIES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-495-6522
Mailing Address - Street 1:7629 GIRARD AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0076
Mailing Address - Country:US
Mailing Address - Phone:773-495-6522
Mailing Address - Fax:858-255-8364
Practice Address - Street 1:7629 GIRARD AVE
Practice Address - Street 2:STE 201
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0076
Practice Address - Country:US
Practice Address - Phone:773-495-6522
Practice Address - Fax:858-255-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24707225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty