Provider Demographics
NPI:1518170943
Name:KIDS POSSIBLE THERAPY L.L.C.
Entity Type:Organization
Organization Name:KIDS POSSIBLE THERAPY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:623-910-2398
Mailing Address - Street 1:7009 W PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9448
Mailing Address - Country:US
Mailing Address - Phone:623-910-2398
Mailing Address - Fax:623-561-9591
Practice Address - Street 1:7009 W PONTIAC DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-9448
Practice Address - Country:US
Practice Address - Phone:623-910-2398
Practice Address - Fax:623-561-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ922981OtherAHCCCS