Provider Demographics
NPI:1932864519
Name:FUNCTION FORWARD KIDS GYM L.L.C.
Entity Type:Organization
Organization Name:FUNCTION FORWARD KIDS GYM L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-250-0211
Mailing Address - Street 1:1304 OLD EVANGELINE HWY
Mailing Address - Street 2:
Mailing Address - City:EVANGELINE
Mailing Address - State:LA
Mailing Address - Zip Code:70537-3304
Mailing Address - Country:US
Mailing Address - Phone:337-250-0211
Mailing Address - Fax:
Practice Address - Street 1:1304 OLD EVANGELINE HWY
Practice Address - Street 2:
Practice Address - City:EVANGELINE
Practice Address - State:LA
Practice Address - Zip Code:70537-3304
Practice Address - Country:US
Practice Address - Phone:337-250-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty