Provider Demographics
NPI:1003607011
Name:KIDCENTRIC PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:KIDCENTRIC PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GARMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-394-5821
Mailing Address - Street 1:4900 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-7944
Mailing Address - Country:US
Mailing Address - Phone:816-394-5821
Mailing Address - Fax:
Practice Address - Street 1:4900 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-7944
Practice Address - Country:US
Practice Address - Phone:816-394-5821
Practice Address - Fax:816-394-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health