Healthcare Provider Details

I. General information

NPI: 1649914912
Provider Name (Legal Business Name): AUSTIN ATHLETIC PERFORMANCE AND RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2022
Last Update Date: 04/23/2022
Certification Date: 04/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 BROTEN ST
AUSTIN TX
78748-3080
US

IV. Provider business mailing address

12124 BROTEN ST
AUSTIN TX
78748-3080
US

V. Phone/Fax

Practice location:
  • Phone: 201-341-9119
  • Fax:
Mailing address:
  • Phone: 201-341-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DENNIS KIHLBERG
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT, DPT
Phone: 201-341-9119