Provider Demographics
NPI:1710148747
Name:KIDZ ON THE MOVE PEDIATRIC REHAB
Entity Type:Organization
Organization Name:KIDZ ON THE MOVE PEDIATRIC REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMANNA
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:908-369-3669
Mailing Address - Street 1:378 S BRANCH RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-8207
Mailing Address - Country:US
Mailing Address - Phone:908-369-3669
Mailing Address - Fax:908-369-3993
Practice Address - Street 1:378 S BRANCH RD
Practice Address - Street 2:SUITE 405
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-8207
Practice Address - Country:US
Practice Address - Phone:908-369-3669
Practice Address - Fax:908-369-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA004541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty