Provider Demographics
NPI:1902063068
Name:KIDSPIRATION PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:KIDSPIRATION PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:619-804-1630
Mailing Address - Street 1:12460 CAMINITO MIRA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2368
Mailing Address - Country:US
Mailing Address - Phone:619-804-1630
Mailing Address - Fax:858-217-4139
Practice Address - Street 1:12460 CAMINITO MIRA DEL MAR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2368
Practice Address - Country:US
Practice Address - Phone:619-804-1630
Practice Address - Fax:858-217-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty