Organization
KIDSOURCE THERAPY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY JESTER (EXECUTIVE DIRECTOR)
(501) 315-4414
Entity
Organization
Contact information
Practice address
610 W GRAND AVE, HOT SPRINGS, AR 71901-3922
(501) 580-3124
Mailing address
17706 I 30 STE 3, BENTON, AR 72019-2930
(501) 315-4414
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/11/2016
Last updated
02/11/2016
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