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General NPI Number Information
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NPI Number | 1780711846
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Entity Type | Organization
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Legal Business Name | KENAI KIDS THERAPY INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 N WILLOW ST STE 15
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City | KENAI
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State | AK
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Zip | 99611-9109
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Country | US
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Telephone | 907-283-2765
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Fax | 907-283-2765
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Provider Business Mailing Address
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Address Line | 48584 DEBRA CIR
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City | KENAI
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State | AK
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Zip | 99611-9436
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Country | US
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Telephone | 907-776-5784
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Fax | 907-776-5786
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Authorized Official
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Title or Position | TREASURER, SECRETARY
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Name | MRS. LISA L REISCHACH
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Credential |
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Telephone | 907-776-5784
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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 | 911
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License Number State | AK
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