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NPI Code Detail

MEDICARE: EXCEPTIONAL KIDZ REHABILITATION

MEDICARE: EXCEPTIONAL KIDZ REHABILITATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2225100000XPhysical Therapist
3225X00000XOccupational Therapist
4235Z00000XSpeech-Language Pathologist
5261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1801219092
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXCEPTIONAL KIDZ REHABILITATION
Provider Business Mailing Address
First Line : 14500 BUSTLETON AVE
Second Line : SUITE 1A
City : PHILADELPHIA
State : PA
Zip : 19116-1188
Country : US
Telephone Number : 215-631-6523
Fax Number :
Provider Business Practice Location Address
First Line : 3 BRIDGE ST
Second Line : PHYSICAL THERAPY SUITE
City : CARTHAGE
State : NY
Zip : 13619-1360
Country : US
Telephone Number : 215-613-6523
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MONICA LASALLE
Credential :
Telephone Number : 215-613-6523
Provider Enumeration Date : 01/24/2014
Last Update Date : 01/27/2014

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Directions to “EXCEPTIONAL KIDZ REHABILITATION ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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