Provider Demographics
NPI:1568977726
Name:KID'S PLAY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:KID'S PLAY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEJAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:720-933-4284
Mailing Address - Street 1:16216 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3549
Mailing Address - Country:US
Mailing Address - Phone:720-933-4284
Mailing Address - Fax:
Practice Address - Street 1:16216 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3549
Practice Address - Country:US
Practice Address - Phone:720-933-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000156544Medicaid