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NPI Code Detail

MEDICARE: KIDS THERAPY PLACE, LLC

MEDICARE: KIDS THERAPY PLACE, 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
1225100000XPhysical Therapist
2235Z00000XSpeech-Language Pathologist
3225X00000XOccupational Therapist

General Provider Information

NPI Number : 1952068363
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS THERAPY PLACE, LLC
Provider Business Mailing Address
First Line : 1225 TRIUMPH CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-7122
Country : US
Telephone Number : 248-930-2554
Fax Number :
Provider Business Practice Location Address
First Line : 1225 TRIUMPH CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-7122
Country : US
Telephone Number : 248-930-2554
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : JONAH KALEIAHI MAWAE
Credential : DPT
Telephone Number : 253-686-2094
Provider Enumeration Date : 11/19/2021
Last Update Date : 11/19/2021

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Directions to “KIDS THERAPY PLACE, LLC ” 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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