Healthcare Provider Details

I. General information

NPI: 1295494888
Provider Name (Legal Business Name): KRU WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 12/11/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 LONE STAR TRL
ATLANTA GA
30340-5021
US

IV. Provider business mailing address

2923 LONE STAR TRL
ATLANTA GA
30340-5021
US

V. Phone/Fax

Practice location:
  • Phone: 313-995-0724
  • Fax:
Mailing address:
  • Phone:
  • 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: KIRA UNDERWOOD
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: DPT
Phone: 313-995-0724