Healthcare Provider Details

I. General information

NPI: 1013352111
Provider Name (Legal Business Name): KIDS THAT CAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 SENOIA ROAD SUITE A1
TYRONE GA
30290-1640
US

IV. Provider business mailing address

1130 SENOIA ROAD SUITE A1
TYRONE GA
30290-1640
US

V. Phone/Fax

Practice location:
  • Phone: 678-632-6765
  • Fax: 678-550-7931
Mailing address:
  • Phone: 678-632-6765
  • Fax: 678-550-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT NYE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 678-632-6765