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General NPI Number Information
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NPI Number | 1124175237
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Entity Type | Organization
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Legal Business Name | KID POTENTIAL, INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2912 W DAVIS ST SUITE 140
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City | CONROE
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State | TX
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Zip | 77304-2041
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Country | US
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Telephone | 936-539-4574
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Fax | 936-539-4585
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Provider Business Mailing Address
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Address Line | PO BOX 2805
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City | CONROE
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State | TX
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Zip | 77305-2805
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Country | US
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Telephone | 936-539-4574
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Fax | 936-539-4585
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. JUDY FAULKNER
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Credential |
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Telephone | 936-539-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State | TX
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