Provider Demographics
NPI:1316913189
Name:KIDS ON THE GO LLC
Entity type:Organization
Organization Name:KIDS ON THE GO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAN DAMME
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-352-0443
Mailing Address - Street 1:19121 E. CRESTRIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015
Mailing Address - Country:US
Mailing Address - Phone:720-352-0443
Mailing Address - Fax:720-870-5642
Practice Address - Street 1:19121 E. CRESTRIDGE CIRCLE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015
Practice Address - Country:US
Practice Address - Phone:720-352-0443
Practice Address - Fax:720-870-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68762251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11172533Medicaid