Provider Demographics
NPI:1407923808
Name:KIDS THERAPY SPECIALTIES LLC
Entity Type:Organization
Organization Name:KIDS THERAPY SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:254-644-2423
Mailing Address - Street 1:4900 SANGER AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5866
Mailing Address - Country:US
Mailing Address - Phone:254-848-6284
Mailing Address - Fax:254-848-4193
Practice Address - Street 1:4900 SANGER AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5866
Practice Address - Country:US
Practice Address - Phone:254-848-6284
Practice Address - Fax:254-848-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333160501Medicaid