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General NPI Number Information
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NPI Number | 1518170943
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Entity Type | Organization
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Legal Business Name | KIDS POSSIBLE THERAPY L.L.C.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7009 W PONTIAC DR
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City | GLENDALE
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State | AZ
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Zip | 85308-9448
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Country | US
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Telephone | 623-910-2398
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Fax | 623-561-9591
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Provider Business Mailing Address
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Address Line | 7009 W PONTIAC DR
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City | GLENDALE
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State | AZ
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Zip | 85308-9448
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Country | US
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Telephone | 623-910-2398
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Fax | 623-561-9591
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Authorized Official
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Title or Position | OWNER PHYSICAL THERAPIST
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Name | MRS. KIMBERLY A BROWN
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Credential | PT
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Telephone | 623-910-2398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3595
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License Number State | AZ
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