Provider Demographics
NPI:1609115062
Name:KID STRIDES THERAPY, LLC
Entity Type:Organization
Organization Name:KID STRIDES THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:336-963-2365
Mailing Address - Street 1:5746 ROLLING MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-7896
Mailing Address - Country:US
Mailing Address - Phone:336-963-2365
Mailing Address - Fax:336-217-8533
Practice Address - Street 1:5746 ROLLING MEADOWS RD
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-7896
Practice Address - Country:US
Practice Address - Phone:336-963-2365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty