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General NPI Number Information
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NPI Number | 1952837288
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Entity Type | Organization
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Legal Business Name | COURAGEOUS KIDS, LLC
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 9263 OSBORN RD
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City | ARLINGTON
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State | TN
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Zip | 38002-5922
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Country | US
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Telephone | 901-496-1057
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Fax |
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Provider Business Mailing Address
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Address Line | 9263 OSBORN RD
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City | ARLINGTON
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State | TN
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Zip | 38002-5922
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Country | US
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Telephone | 901-496-1057
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. HEATHER LAUREN JACKSON
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Credential | PT, DPT
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Telephone | 901-496-1057
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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 | 0000009799
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License Number State | TN
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