NPIMap

Organization Active NPI

Compleat Kidz Pediatric Therapy, LLC

  • Physical Therapist
  • Richmond, VA
National Provider Identifier
1508688805
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
COMPLEAT KIDZ PEDIATRIC THERAPY, LLC
Practice address
919 E Main Street
Suite 1000
Richmond, VA 23219-4623
Phone
(704) 915-6193
NPI assigned
Oct 28, 2024
Last updated
Oct 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMPLEAT KIDZ PEDIATRIC THERAPY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Authorized official

Name
Mr. Derrick Fickling
Title
Senior Payer Relations Manager
Phone
(888) 580-6180

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU
Behavior Analyst 103K00000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

919 E Main Street
Suite 1000
Richmond, VA 23219-4623

Mailing address

PO Box 749
Belmont, NC 28012-0749
Phone (704) 915-6193

National Provider Directory

National Provider Directory
Tax ID family
Compleat Kidz Pediatric Therapy LLC2 organizations share this tax ID, including this one
Part of
Compleat Kidz Pediatric Therapy LLC

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1508688805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "280120749",
            "telephone_number": "704-915-6193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 E MAIN STREET",
            "address_2": "SUITE 1000",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232194623",
            "telephone_number": "704-915-6193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLEAT KIDZ PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMPLEAT KIDZ PEDIATRIC THERAPY, LLC",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "FICKLING",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "SENIOR PAYER RELATIONS MANAGER",
        "authorized_official_telephone_number": "888-580-6180",
        "authorized_official_name_prefix": "Mr."
    },
    "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
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.