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General NPI Number Information
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NPI Number | 1104546241
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Entity Type | Organization
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Legal Business Name | KNEE REJUVENATION GROUP OF FLORIDA
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 2114 AIRPORT BLVD STE 1500
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City | PENSACOLA
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State | FL
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Zip | 32504-5910
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Country | US
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Telephone | 850-979-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 AIRPORT BLVD STE 1500
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City | PENSACOLA
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State | FL
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Zip | 32504-5910
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Country | US
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Telephone | 850-979-5633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN KRAUSE
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Credential |
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Telephone | 850-979-5633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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