Provider Demographics
NPI:1598724577
Name:K.I.D.S. THERAPY ASSOCIATES, INC., A PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:K.I.D.S. THERAPY ASSOCIATES, INC., A PHYSICAL THERAPY CORPORATION
Other - Org Name:HEALTHPRO PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-PEDIATRICS DIVISION
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-437-4364
Mailing Address - Street 1:11838 BERNARDO PLAZA CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2413
Mailing Address - Country:US
Mailing Address - Phone:858-673-5437
Mailing Address - Fax:858-673-5434
Practice Address - Street 1:11838 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2413
Practice Address - Country:US
Practice Address - Phone:858-673-5437
Practice Address - Fax:858-673-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09412ZOtherBLUE SHIELD SPEECH PIN #
CAZZZ09413ZOtherBLUE SHIELD OT PIN #
CAZZZ09414ZOtherBLUE SHIELD PT PIN #