Healthcare Provider Details

I. General information

NPI: 1598724577
Provider Name (Legal Business Name): K.I.D.S. THERAPY ASSOCIATES, INC., A PHYSICAL THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/14/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11838 BERNARDO PLAZA CT SUITE 110
SAN DIEGO CA
92128-2413
US

IV. Provider business mailing address

11838 BERNARDO PLAZA CT SUITE 110
SAN DIEGO CA
92128-2413
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-5437
  • Fax: 858-673-5434
Mailing address:
  • Phone: 858-673-5437
  • Fax: 858-673-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TERRA SCOTT
Title or Position: PRESIDENT-PEDIATRICS DIVISION
Credential: MSPT
Phone: 303-437-4364