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NPI Code Detail

MEDICARE: KIDS PLAY SENSORY GYM LLC

MEDICARE: KIDS PLAY SENSORY GYM LLC
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1922518463
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS PLAY SENSORY GYM LLC
Provider Business Mailing Address
First Line : 2010 S YOST AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3188
Country : US
Telephone Number : 812-822-0605
Fax Number :
Provider Business Practice Location Address
First Line : 2010 S YOST AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3188
Country : US
Telephone Number : 812-822-0605
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KATHLEEN RADER
Credential :
Telephone Number : 812-822-0605
Provider Enumeration Date : 10/11/2017
Last Update Date : 11/05/2024

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Directions to “KIDS PLAY SENSORY GYM LLC ” Practice Location

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