Healthcare Provider Details

I. General information

NPI: 1578487831
Provider Name (Legal Business Name): CHIEF PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE 3RD AVE
FORT LAUDERDALE FL
33301-1148
US

IV. Provider business mailing address

805 SE 3RD AVE
FT LAUDERDALE FL
33316-1105
US

V. Phone/Fax

Practice location:
  • Phone: 954-256-9052
  • Fax: 954-256-9053
Mailing address:
  • Phone: 954-256-9052
  • Fax: 954-256-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARSON KUTUCHIEF
Title or Position: OWNER
Credential: DPT
Phone: 954-256-9052