Provider Demographics
NPI:1457136293
Name:PHYSIO KIDS LLC
Entity Type:Organization
Organization Name:PHYSIO KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREFTING
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:970-759-6077
Mailing Address - Street 1:19820 VILLAGE OFFICE CT STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2949
Mailing Address - Country:US
Mailing Address - Phone:541-410-6132
Mailing Address - Fax:
Practice Address - Street 1:19820 VILLAGE OFFICE CT STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2949
Practice Address - Country:US
Practice Address - Phone:541-410-6132
Practice Address - Fax:541-209-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy