Healthcare Provider Details

I. General information

NPI: 1306299136
Provider Name (Legal Business Name): RALPH KRUGLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 07/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 SW 14TH ST
BOCA RATON FL
33486-5313
US

IV. Provider business mailing address

1381 SW 14TH ST
BOCA RATON FL
33486-5313
US

V. Phone/Fax

Practice location:
  • Phone: 954-649-3207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL1733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: