Provider Demographics
NPI:1417667346
Name:KIDZ VILLAGE THERAPY CLINIC LLC
Entity Type:Organization
Organization Name:KIDZ VILLAGE THERAPY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAILENE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-616-4441
Mailing Address - Street 1:19 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5711
Mailing Address - Country:US
Mailing Address - Phone:407-616-4441
Mailing Address - Fax:
Practice Address - Street 1:19 BROADWAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5711
Practice Address - Country:US
Practice Address - Phone:407-616-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty