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General NPI Number Information
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NPI Number | 1104523182
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Entity Type | Organization
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Legal Business Name | KIDZONE PEDIATRICS, LLC
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 208 EAST POPE ST
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City | TAYLOR
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State | AR
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Zip | 71861
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Country | US
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Telephone | 870-904-2243
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | TAYLOR
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State | AR
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Zip | 71861-0146
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Country | US
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Telephone | 870-904-2243
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | SHELBY COLVIN
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Credential |
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Telephone | 870-904-2243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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