Provider Demographics
NPI:1740607431
Name:KIDZ PALACE THERAPY LLC
Entity Type:Organization
Organization Name:KIDZ PALACE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-476-0702
Mailing Address - Street 1:7123 INTERSTATE 30 STE 25
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-3184
Mailing Address - Country:US
Mailing Address - Phone:501-476-0702
Mailing Address - Fax:866-521-5461
Practice Address - Street 1:7123 INTERSTATE 30 STE 25
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3184
Practice Address - Country:US
Practice Address - Phone:501-476-0702
Practice Address - Fax:866-521-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation