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General NPI Number Information
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NPI Number | 1902252059
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Entity Type | Organization
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Legal Business Name | KINETIC KIDS, INC.
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 421 WOODS EDGE DR
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City | SOMERSET
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State | KY
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Zip | 42503-5604
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Country | US
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Telephone | 606-219-1908
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Fax | 606-678-0874
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Provider Business Mailing Address
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Address Line | 421 WOODS EDGE DR
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City | SOMERSET
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State | KY
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Zip | 42503-5604
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Country | US
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Telephone | 606-219-1908
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Fax | 606-678-0874
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Authorized Official
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Title or Position | PT/ PRES.
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Name | LAURA S POPE
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Credential |
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Telephone | 606-219-1908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 001530
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License Number State | KY
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