Provider Demographics
NPI:1598813792
Name:KID-ABILITY MOBILE PEDIATRIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:KID-ABILITY MOBILE PEDIATRIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRASAWA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-418-8264
Mailing Address - Street 1:PO BOX 82338
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85071-2338
Mailing Address - Country:US
Mailing Address - Phone:602-418-8264
Mailing Address - Fax:602-482-9498
Practice Address - Street 1:2726 E ACOMA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4900
Practice Address - Country:US
Practice Address - Phone:602-418-8264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty