Provider Demographics
NPI:1124175237
Name:KID POTENTIAL, INC.
Entity type:Organization
Organization Name:KID POTENTIAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-539-4574
Mailing Address - Street 1:PO BOX 2805
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-2805
Mailing Address - Country:US
Mailing Address - Phone:936-539-4574
Mailing Address - Fax:936-539-4585
Practice Address - Street 1:2912 W DAVIS ST
Practice Address - Street 2:SUITE 140
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2041
Practice Address - Country:US
Practice Address - Phone:936-539-4574
Practice Address - Fax:936-539-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)