Provider Demographics
NPI:1053573634
Name:KIDSPOT PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:KIDSPOT PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:303-604-6441
Mailing Address - Street 1:165 MCCASLIN BLVD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027
Mailing Address - Country:US
Mailing Address - Phone:303-604-6441
Mailing Address - Fax:303-957-1955
Practice Address - Street 1:165 MCCASLIN BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-604-6441
Practice Address - Fax:303-957-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99978245Medicaid