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General NPI Number Information
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NPI Number | 1609115062
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Entity Type | Organization
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Legal Business Name | KID STRIDES THERAPY, LLC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 5746 ROLLING MEADOWS RD
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City | RANDLEMAN
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State | NC
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Zip | 27317-7896
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Country | US
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Telephone | 336-963-2365
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Fax |
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Provider Business Mailing Address
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Address Line | 5746 ROLLING MEADOWS RD
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City | RANDLEMAN
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State | NC
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Zip | 27317-7896
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Country | US
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Telephone | 336-963-2365
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Fax | 336-217-8533
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. AMANDA BETH PEARCE
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Credential | PT
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Telephone | 336-963-2365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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