Kickstart Pediatric Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

KICKSTART PEDIATRIC THERAPY LLC

Practice address

2920 Glohaven Dr
Conway, AR 72034-9656

Phone

(501) 733-6929

NPI assigned

Apr 10, 2015

Organization subpart

No

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

Authorized official

Name

Deeann Smith, MSPT

Title

Physical Therapist

Phone

(501) 472-4923

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428624000000",
    "number": "1679969216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 GLOHAVEN DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720349656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 GLOHAVEN DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720349656",
            "telephone_number": "501-733-6929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKSTART PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-10",
        "last_updated": "2015-04-10",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DEEANN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "501-472-4923",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Kershner, DC
• Trina Kervin, MS CCC-SLP
• Christoni Key
• Christopher G Key, MS
• Sheza Tauheed Khawaja, MD
• Kid Success, Inc.
• Amanda Jean Kidd
• Ellie Nicole Kidd, OT
• Kids ABA Services
• Kidz Choice Conway LLC

• Physical Therapist in Conway, AR
• Providers in Conway, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; 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.