Provider Demographics
NPI:1619196649
Name:KSPOTSLP
Entity Type:Organization
Organization Name:KSPOTSLP
Other - Org Name:SOLARI PEDIATRIC OUTPATIENT THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERDIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BENTLEY
Authorized Official - Last Name:SOLARI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:972-404-1718
Mailing Address - Street 1:12810 HILLCREST RD
Mailing Address - Street 2:B100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1525
Mailing Address - Country:US
Mailing Address - Phone:972-404-1718
Mailing Address - Fax:972-404-9006
Practice Address - Street 1:12810 HILLCREST RD
Practice Address - Street 2:B100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1525
Practice Address - Country:US
Practice Address - Phone:972-404-1718
Practice Address - Fax:972-404-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102079261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy