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General NPI Number Information
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NPI Number | 1245607696
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Entity Type | Organization
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Legal Business Name | MONDO SPORTS THERAPY, LLC
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 4201 MARATHON BLVD STE 204
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City | AUSTIN
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State | TX
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Zip | 78756-3409
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Country | US
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Telephone | 512-422-4258
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Fax | 512-300-2519
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Provider Business Mailing Address
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Address Line | 7109 SPURLOCK DR
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City | AUSTIN
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State | TX
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Zip | 78731-2134
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Country | US
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Telephone | 512-422-4258
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Fax |
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Authorized Official
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Title or Position | OWNER/PT
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Name | DR. PIERRE AUGUSTINUS KROON
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Credential | DPT
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Telephone | 512-422-4258
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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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