Miracle Kids Success Academy North

NPI #1902378037 in Jonesboro, Arkansas

Provider Information

NPI Number: 1902378037
Entity Type: Organization
Organization Name: Miracle Kids Success Academy North
Subpart: Yes (part of a larger organization)
Parent Organization: MIRACLE KIDS SUCCESS ACADEMY
Primary Specialty: Physical Therapist
Enumeration Date: Dec 31, 2018
Last Updated: Dec 31, 2018

Practice Location

Address: 806 GLENDALE ST
City: Jonesboro
State: Arkansas
ZIP Code: 72401-4455
Phone: (870) 932-3600

Authorized Official

Name: SHELLY KELLER
Title: CEO/OWNER
Phone: (870) 761-6680

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Speech-Language Pathologist	235Z00000X
Physical Therapist	225100000X	Primary

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