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General NPI Number Information
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NPI Number | 1003007659
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Entity Type | Organization
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Legal Business Name | KIDS IN BALANCE, INC.
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 10022 WATER WORKS LN
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City | RIVERVIEW
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State | FL
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Zip | 33578-5301
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Country | US
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Telephone | 813-677-8450
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Fax | 813-677-5029
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Provider Business Mailing Address
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Address Line | 4507 COMPASS OAKS DR
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City | VALRICO
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State | FL
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Zip | 33596-7390
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Country | US
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Telephone | 813-677-8450
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Fax | 813-677-5029
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Authorized Official
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Title or Position | DIR./SPEECH LANGUAGE PATHOLOGIST
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Name | MS. JENNIFER A LEIGH
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Credential | M.S. CCC-SLP
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Telephone | 813-677-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | CH21861
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License Number State | FL
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