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Organization
ALPHA KIDS SHINE
Active
Organization
ALPHA KIDS SHINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDI EDMONDS PHYSICAL THERAPIST (OWNER)
(773) 828-9106
Entity
Organization
Contact information
Practice address
8612 S PAULINA ST, CHICAGO, IL 60620-4849
(773) 828-9106
Mailing address
525 S CHURCH ST APT 1911, CHARLOTTE, NC 28202-3321
(773) 828-9106
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
12/30/2018
Last updated
12/30/2018
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