Healthcare Provider Details

I. General information

NPI: 1194300640
Provider Name (Legal Business Name): PT KR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLEARWATER LARGO RD S
LARGO FL
33770-3228
US

IV. Provider business mailing address

200 CLEARWATER LARGO RD S
LARGO FL
33770-3235
US

V. Phone/Fax

Practice location:
  • Phone: 464-872-7581
  • Fax:
Mailing address:
  • Phone: 904-422-5231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN RYAN ROCKEFELLER
Title or Position: MANAGER
Credential:
Phone: 904-422-5231