Provider Demographics
NPI:1982765665
Name:KIDS ADVANCE REHAB SERVICES, LLC
Entity Type:Organization
Organization Name:KIDS ADVANCE REHAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOVITO
Authorized Official - Middle Name:T
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:812-234-6540
Mailing Address - Street 1:676 E SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-6804
Mailing Address - Country:US
Mailing Address - Phone:812-234-6540
Mailing Address - Fax:812-234-6541
Practice Address - Street 1:676 E SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-6804
Practice Address - Country:US
Practice Address - Phone:812-234-6540
Practice Address - Fax:812-234-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002904A225100000X, 2251P0200X
IN05002960A225100000X, 2251P0200X
IN06002210A225200000X
IN31003318A225X00000X, 225XP0200X
IN31001418A225X00000X, 225XP0200X
IN22002410A235Z00000X
IN22002247A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty