Provider Demographics
NPI:1154531309
Name:KRIS' CAMP/ THERAPY INTENSIVE PROGRAMS, INC
Entity type:Organization
Organization Name:KRIS' CAMP/ THERAPY INTENSIVE PROGRAMS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN ISPELEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-733-0721
Mailing Address - Street 1:3359 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:807-733-0721
Mailing Address - Fax:807-942-1750
Practice Address - Street 1:25955 CEDAR ST
Practice Address - Street 2:
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549-5840
Practice Address - Country:US
Practice Address - Phone:801-598-7735
Practice Address - Fax:801-942-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-0016091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty