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General NPI Number Information
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NPI Number | 1720537657
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Entity Type | Organization
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Legal Business Name | GO KID GO THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 131 FLINN STREET SUITE A
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City | BATAVIA
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State | IL
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Zip | 60510
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Country | US
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Telephone | 630-425-3134
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Fax |
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Provider Business Mailing Address
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Address Line | 7 RALPH JUDD CT
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City | SUGAR GROVE
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State | IL
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Zip | 60554-4010
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Country | US
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Telephone | 630-240-2962
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Fax | 630-405-1129
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LISA JOSUPAIT
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Credential | P.T.
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Telephone | 630-240-2962
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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 | 070012467
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License Number State | IL
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