=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578487831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIEF PHYSICAL THERAPY AND SPORTS MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2026
-----------------------------------------------------
Last Update Date | 08/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 NE 3RD AVE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33301-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-256-9052
-----------------------------------------------------
Fax | 954-256-9053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 SE 3RD AVE
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33316-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-256-9052
-----------------------------------------------------
Fax | 954-256-9053
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CARSON KUTUCHIEF
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 954-256-9052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------