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General NPI Number Information
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NPI Number | 1922384080
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Entity Type | Organization
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Legal Business Name | KIDS ABILITIES INDIANA, INC.
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 1788 WINDWARD DR
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City | GREENWOOD
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State | IN
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Zip | 46143-8408
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Country | US
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Telephone | 651-470-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 490 HIGHWAY 96 W SUITE 300
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City | SHOREVIEW
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State | MN
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Zip | 55126-1960
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Country | US
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Telephone | 651-451-3016
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Fax | 651-481-7040
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JENNIFER SARGENT
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Credential | PT
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Telephone | 651-451-3016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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