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General NPI Number Information
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NPI Number | 1902063068
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Entity Type | Organization
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Legal Business Name | KIDSPIRATION PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 12460 CAMINITO MIRA DEL MAR
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City | SAN DIEGO
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State | CA
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Zip | 92130-2368
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Country | US
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Telephone | 619-804-1630
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Fax | 858-217-4139
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Provider Business Mailing Address
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Address Line | 12460 CAMINITO MIRA DEL MAR
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City | SAN DIEGO
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State | CA
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Zip | 92130-2368
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Country | US
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Telephone | 619-804-1630
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Fax | 858-217-4139
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MICHELE ROONEY
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Credential | MS, PT
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Telephone | 619-804-1630
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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 | 28219
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License Number State | CA
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