Healthcare Provider Details

I. General information

NPI: 1205219979
Provider Name (Legal Business Name): LAILA KRECH PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 RACETRACK RD NW
FORT WALTON BEACH FL
32547-1553
US

IV. Provider business mailing address

310 RACETRACK RD NW
FORT WALTON BEACH FL
32547-1553
US

V. Phone/Fax

Practice location:
  • Phone: 850-889-4550
  • Fax:
Mailing address:
  • Phone: 850-889-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41440
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: