Healthcare Provider Details

I. General information

NPI: 1770410755
Provider Name (Legal Business Name): ROOTED KIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 LAKE PARK LOOP
MOUNTAIN HOME AR
72653-6770
US

IV. Provider business mailing address

299 LAKE PARK LOOP
MOUNTAIN HOME AR
72653-6770
US

V. Phone/Fax

Practice location:
  • Phone: 417-522-3332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOLLY CHILTON
Title or Position: OWNER
Credential: OTR/L
Phone: 417-522-3332