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General NPI Number Information
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NPI Number | 1013792555
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Entity Type | Organization
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Legal Business Name | FIT TO BE KIDS PEDIATRIC PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 1809 W 25TH CT
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City | STILLWATER
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State | OK
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Zip | 74074-6948
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Country | US
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Telephone | 318-349-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 1809 W 25TH CT
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City | STILLWATER
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State | OK
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Zip | 74074-6948
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Country | US
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Telephone | 318-349-0290
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND FOUNDER
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Name | KAYTE LEA LYNCH
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Credential | PT, DPT
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Telephone | 318-349-0290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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