Provider Demographics
NPI:1922384080
Name:KIDS ABILITIES INDIANA, INC.
Entity Type:Organization
Organization Name:KIDS ABILITIES INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:651-451-3016
Mailing Address - Street 1:490 HIGHWAY 96 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1960
Mailing Address - Country:US
Mailing Address - Phone:651-451-3016
Mailing Address - Fax:651-481-7040
Practice Address - Street 1:1788 WINDWARD DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8408
Practice Address - Country:US
Practice Address - Phone:651-470-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy