Provider Demographics
NPI:1801219092
Name:EXCEPTIONAL KIDZ REHABILITATION
Entity Type:Organization
Organization Name:EXCEPTIONAL KIDZ REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-613-6523
Mailing Address - Street 1:14500 BUSTLETON AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1188
Mailing Address - Country:US
Mailing Address - Phone:215-631-6523
Mailing Address - Fax:
Practice Address - Street 1:3 BRIDGE ST
Practice Address - Street 2:PHYSICAL THERAPY SUITE
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1360
Practice Address - Country:US
Practice Address - Phone:215-613-6523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty