Healthcare Provider Details

I. General information

NPI: 1730591991
Provider Name (Legal Business Name): KIDOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 N FLINT STREET
LINCOLNTON NC
28092-5239
US

IV. Provider business mailing address

1244 N FLINT STREET
LINCOLNTON NC
28092-5239
US

V. Phone/Fax

Practice location:
  • Phone: 855-983-0488
  • Fax: 704-240-3500
Mailing address:
  • Phone: 855-983-0488
  • Fax: 704-240-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberP12658
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BARTLEY V HEATH
Title or Position: CFO/PARTNER
Credential:
Phone: 855-983-0488