Provider Demographics
NPI:1609330372
Name:KIDS CARE PEDIATRIC THERAPIES
Entity Type:Organization
Organization Name:KIDS CARE PEDIATRIC THERAPIES
Other - Org Name:KIDS CARE PEDIATRIC THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:417-812-5031
Mailing Address - Street 1:1441 E KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4101
Mailing Address - Country:US
Mailing Address - Phone:417-812-5031
Mailing Address - Fax:
Practice Address - Street 1:1441 E KEARNEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4101
Practice Address - Country:US
Practice Address - Phone:417-812-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty