Provider Demographics
NPI:1053921502
Name:KID PHYSICAL LLC
Entity type:Organization
Organization Name:KID PHYSICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-593-6868
Mailing Address - Street 1:16350 E ARAPAHOE RD STE 146
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1557
Mailing Address - Country:US
Mailing Address - Phone:860-593-6868
Mailing Address - Fax:
Practice Address - Street 1:18885 E EASTER PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-2136
Practice Address - Country:US
Practice Address - Phone:860-593-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-08
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251E00000XAgenciesHome Health