Provider Demographics
NPI:1952068363
Name:KIDS THERAPY PLACE, LLC
Entity Type:Organization
Organization Name:KIDS THERAPY PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:KALEIAHI
Authorized Official - Last Name:MAWAE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:253-686-2094
Mailing Address - Street 1:1225 TRIUMPH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7122
Mailing Address - Country:US
Mailing Address - Phone:248-930-2554
Mailing Address - Fax:
Practice Address - Street 1:1225 TRIUMPH CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7122
Practice Address - Country:US
Practice Address - Phone:248-930-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty