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General NPI Number Information
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NPI Number | 1801219092
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL KIDZ REHABILITATION
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 3 BRIDGE ST PHYSICAL THERAPY SUITE
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City | CARTHAGE
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State | NY
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Zip | 13619-1360
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Country | US
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Telephone | 215-613-6523
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Fax |
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Provider Business Mailing Address
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Address Line | 14500 BUSTLETON AVE SUITE 1A
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City | PHILADELPHIA
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State | PA
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Zip | 19116-1188
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Country | US
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Telephone | 215-631-6523
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA LASALLE
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Credential |
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Telephone | 215-613-6523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family 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 | 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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Taxonomy #3
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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 #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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