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General NPI Number Information
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NPI Number | 1295545721
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Entity Type | Organization
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Legal Business Name | RADIANCE PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 207 NW HIGHLAND RD
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City | BENTONVILLE
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State | AR
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Zip | 72712-7198
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Country | US
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Telephone | 479-282-4477
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Fax | 479-391-5269
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Provider Business Mailing Address
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Address Line | 207 NW HIGHLAND RD
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City | BENTONVILLE
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State | AR
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Zip | 72712-7198
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Country | US
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Telephone | 479-282-4477
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Fax | 479-391-5269
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER KLOSTER
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Credential | OTR/L
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Telephone | 479-282-4477
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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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