NPIMap

Organization Active NPI

Kids Therapy Specialties LLC

  • Physical Therapist
  • Waco, TX
National Provider Identifier
1407923808
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
KIDS THERAPY SPECIALTIES LLC
Practice address
4900 Sanger Ave
Waco, TX 76710-5866
Phone
(254) 848-6284
Fax
(254) 848-4193
NPI assigned
Nov 29, 2006
Last updated
Jul 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Juliet Eileen Melton, PT
Title
Physical Therapist President
Phone
(254) 644-2423

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU
Behavior Analyst 103K00000X NU

Addresses

Primary practice location

4900 Sanger Ave
Waco, TX 76710-5866

Mailing address

4900 Sanger Ave
Waco, TX 76710-5866
Phone (254) 848-6284

Other practice location 1

1008 Arbor Park Ste A
Belton, TX 76513-8282
Phone (254) 598-2620

Other identifiers 1

IdentifierTypeStateIssuer
333160501MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090707000697 TX Part B Supplier - Clinic/Group Practice 0840341673 Receives reassigned benefits from 17 practitioners
Practice locations: Waco, TX

National Provider Directory

National Provider Directory
Tax ID family
Kids Therapy Specialties LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2901 SW H K Dodgen Loop
Ste 104
Temple, TX 76502
Phone (254) 644-2423

6701 Sanger Ave
Waco, TX 76710

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1407923808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 SANGER AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767105866",
            "telephone_number": "254-848-6284",
            "fax_number": "254-848-4193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 SANGER AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767105866",
            "telephone_number": "254-848-6284",
            "fax_number": "254-848-4193"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1008 Arbor Park Ste A",
            "address_purpose": "LOCATION",
            "city": "Belton",
            "state": "TX",
            "postal_code": "765138282",
            "country_code": "US",
            "telephone_number": "254-598-2620",
            "fax_number": "254-848-4193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KIDS THERAPY SPECIALTIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "MELTON",
        "authorized_official_first_name": "JULIET",
        "authorized_official_middle_name": "EILEEN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST PRESIDENT",
        "authorized_official_telephone_number": "254-644-2423",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "333160501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.