Provider Demographics
NPI:1508574963
Name:KINDRED PEDIATRIC THERAPY, PLC
Entity Type:Organization
Organization Name:KINDRED PEDIATRIC THERAPY, PLC
Other - Org Name:POST PEDIATRIC THERAPIES- FAYETTEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORTER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:479-435-6636
Mailing Address - Street 1:3162 W MARTIN LUTHER KING JR BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7679
Mailing Address - Country:US
Mailing Address - Phone:479-435-6636
Mailing Address - Fax:
Practice Address - Street 1:3162 W MARTIN LUTHER KING JR BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7679
Practice Address - Country:US
Practice Address - Phone:479-435-6636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy