# ALPHA KIDS SHINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881166981
- **Authorized official:** CHANDI EDMONDS PHYSICAL THERAPIST (OWNER)
- **Authorized official phone:** (773) 828-9106

## Contact information

- **Practice address:** 8612 S PAULINA ST, CHICAGO, IL 60620-4849
- **Practice address phone:** (773) 828-9106
- **Mailing address:** 525 S CHURCH ST APT 1911, CHARLOTTE, NC 28202-3321
- **Mailing address phone:** (773) 828-9106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/30/2018
- **Last updated:** 12/30/2018