Healthcare Provider Details

I. General information

NPI: 1467559740
Provider Name (Legal Business Name): KIDS IN MOTION PEDIATRIC THERAPY SERVICES LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

2636 S MILFORD RD
HIGHLAND MI
48357-4938
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-9610
  • Fax: 248-684-9611
Mailing address:
  • Phone: 248-684-9610
  • Fax: 248-684-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY THERESE HYDORN
Title or Position: PRESIDENT
Credential: PT
Phone: 248-684-9610