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General NPI Number Information
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NPI Number | 1417789645
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Entity Type | Organization
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Legal Business Name | KID GOALS PEDIATRIC PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 619 W RIDGECREST BLVD STE B
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City | RIDGECREST
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State | CA
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Zip | 93555-4065
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Country | US
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Telephone | 760-428-8646
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Fax |
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Provider Business Mailing Address
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Address Line | 200 PALM AVE
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City | CORONADO
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State | CA
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Zip | 92118-1120
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Country | US
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Telephone | 760-428-8646
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Fax | 760-428-8646
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | KIMBERLY BEHNKE
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Credential | PT
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Telephone | 760-428-8646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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