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General NPI Number Information
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NPI Number | 1205515202
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Entity Type | Organization
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Legal Business Name | KRU PT AND PERFORMANCE LAB, LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 1401 GREEN RD STE DEF
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-1080
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Country | US
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Telephone | 570-574-7517
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331004
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City | MIAMI
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State | FL
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Zip | 33233-1004
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Country | US
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Telephone | 570-574-7517
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE KRUPA
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Credential | DPT, CSCS
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Telephone | 570-574-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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