=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245425685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BKR THERAPIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2007
-----------------------------------------------------
Last Update Date | 08/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7431 W ATLANTIC AVE SUITE# 52
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-638-7455
-----------------------------------------------------
Fax | 561-638-7873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7431 WEST ATLANTIC AVENUE SUITE 52
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-638-7455
-----------------------------------------------------
Fax | 561-638-7873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOSHUA ADAM DAVIS
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 561-638-7455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT19193
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 23476
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------