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General NPI Number Information
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NPI Number | 1760043798
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Entity Type | Organization
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Legal Business Name | KRK THERAPY CENTER, INC
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 4176 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4158
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Country | US
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Telephone | 305-418-0336
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Fax | 305-456-3563
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Provider Business Mailing Address
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Address Line | 4148 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4107
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Country | US
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Telephone | 305-418-0336
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. JERONIMA COREA
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Credential |
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Telephone | 786-873-6117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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