Healthcare Provider Details

I. General information

NPI: 1679182968
Provider Name (Legal Business Name): CAN DO KIDS PEDIATRIC THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 SIMPSON ST
BENTON LA
71006-8314
US

IV. Provider business mailing address

613 SIMPSON ST
BENTON LA
71006-8314
US

V. Phone/Fax

Practice location:
  • Phone: 618-599-2295
  • Fax:
Mailing address:
  • Phone: 618-599-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KASEY CARPENTER
Title or Position: OWNER
Credential: LOTR
Phone: 618-599-2295