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General NPI Number Information
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NPI Number | 1508497215
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Entity Type | Organization
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Legal Business Name | ATHLETE RESTORATION COMPANY, LLC
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 512 EVERNIA ST STE 103
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5702
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Country | US
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Telephone | 561-899-8725
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Fax |
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Provider Business Mailing Address
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Address Line | 11899 BAYBERRY ST
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-2107
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Country | US
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Telephone | 561-814-3474
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER/FOUNDER
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Name | DR. KYLE J VOLSTAD
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Credential | PT
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Telephone | 561-899-8725
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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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