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General NPI Number Information
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NPI Number | 1255987970
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Entity Type | Organization
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Legal Business Name | KIDVANCE THERAPY
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Dates
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Enumeration Date | 08/18/2019
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Last Update Date | 08/18/2019
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Provider Practice Location Address
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Address Line | 2103 HILLCIRCLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40214-5939
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Country | US
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Telephone | 502-550-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 HILLCIRCLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40214-5939
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Country | US
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Telephone | 502-550-2158
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATALIE JONES
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Credential | PT, DPT
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Telephone | 502-550-2158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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