Healthcare Provider Details

I. General information

NPI: 1114189420
Provider Name (Legal Business Name): JUST 4 KIDZ THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 S PRESTON RD STE 830
PROSPER TX
75078-1907
US

IV. Provider business mailing address

291 S PRESTON RD STE 830
PROSPER TX
75078-1907
US

V. Phone/Fax

Practice location:
  • Phone: 972-347-9454
  • Fax: 972-499-2527
Mailing address:
  • Phone: 972-347-9454
  • Fax: 972-499-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number110553
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHADDRICK D POLK
Title or Position: C.F.O
Credential:
Phone: 972-283-3100