Provider Demographics
NPI:1689067456
Name:DRAGON PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:DRAGON PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-916-6090
Mailing Address - Street 1:11845 RIVER ESTATES CIR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8603
Mailing Address - Country:US
Mailing Address - Phone:601-916-6090
Mailing Address - Fax:
Practice Address - Street 1:11845 RIVER ESTATES CIR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-8603
Practice Address - Country:US
Practice Address - Phone:601-916-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT46902251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty