MEDICARE: PHYSICAL THERAPY FOR KIDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	783	AK
2	2251P0200X	Pediatric Physical Therapist	783	AK
3	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013240175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY FOR KIDS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1475
Second Line	:
City	:	SISTERS
State	:	OR
Zip	:	97759-1475
Country	:	US
Telephone Number	:	907-346-4096
Fax Number	:	907-346-4097

Provider Business Practice Location Address
First Line	:	1109 N FOREST EDGE DR
Second Line	:
City	:	SISTERS
State	:	OR
Zip	:	97759-2692
Country	:	US
Telephone Number	:	907-346-4096
Fax Number	:	877-319-7365

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHARON SKIDMORE
Credential	:	P.T., D.P.T.
Telephone Number	:	907-346-4096

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	06/22/2021

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Directions to “PHYSICAL THERAPY FOR KIDS, LLC ” Practice Location

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