Healthcare Provider Details

I. General information

NPI: 1164756672
Provider Name (Legal Business Name): KIDZ THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 FORT HILL DR
ALEXANDRIA VA
22310-2105
US

IV. Provider business mailing address

3508 FORT HILL DR
ALEXANDRIA VA
22310-2105
US

V. Phone/Fax

Practice location:
  • Phone: 703-862-6557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARY-KATHERINE DAVIDSON-TAYLOR
Title or Position: DIRECTOR
Credential: MS OTR/L
Phone: 703-862-6557