Healthcare Provider Details

I. General information

NPI: 1588720825
Provider Name (Legal Business Name): KIDZSPOT PEDIATRIC THERAPY-EAST VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 112
MESA AZ
85206-4674
US

IV. Provider business mailing address

4838 E BASELINE RD STE 112
MESA AZ
85206-4674
US

V. Phone/Fax

Practice location:
  • Phone: 480-900-6572
  • Fax:
Mailing address:
  • Phone: 480-900-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BETHANY WARKENTIN
Title or Position: OWNER
Credential:
Phone: 480-900-6572