Provider Demographics
NPI:1558544742
Name:IMPACT KIDS, INC
Entity Type:Organization
Organization Name:IMPACT KIDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-672-4464
Mailing Address - Street 1:451 ARTHUR GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3503
Mailing Address - Country:US
Mailing Address - Phone:305-672-4464
Mailing Address - Fax:305-672-4484
Practice Address - Street 1:451 ARTHUR GODFREY RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3503
Practice Address - Country:US
Practice Address - Phone:305-672-4464
Practice Address - Fax:305-672-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7470261QP2000X
261QR0400X
FLSA8858261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892667100Medicaid