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General NPI Number Information
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NPI Number | 1033593785
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Entity Type | Organization
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Legal Business Name | CAN DO KIDS PEDIATRIC THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 65 MOUSE CREEK RD NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4840
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Country | US
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Telephone | 423-476-7212
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Fax | 423-476-1673
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Provider Business Mailing Address
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Address Line | 65 MOUSE CREEK RD NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4840
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Country | US
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Telephone | 423-476-7212
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Fax | 423-476-1673
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHNATHAN PAUL CISCO
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Credential | OWNER
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Telephone | 423-476-7212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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