Healthcare Provider Details

I. General information

NPI: 1174845358
Provider Name (Legal Business Name): KIDS SPOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 DEAVER ST
SPRINGDALE AR
72764-5356
US

IV. Provider business mailing address

724 DEAVER ST
SPRINGDALE AR
72764-5356
US

V. Phone/Fax

Practice location:
  • Phone: 479-259-2339
  • Fax: 479-439-8600
Mailing address:
  • Phone: 479-259-2339
  • Fax: 479-439-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#1904
License Number StateAR

VIII. Authorized Official

Name: HILLARY BOYD
Title or Position: OWNER, CLINICAL DIRECTOR
Credential: DPT
Phone: 479-259-2339