Provider Demographics
NPI:1114515046
Name:ATHLETIX REHAB AND RECOVERY DEERFIELD, LLC
Entity Type:Organization
Organization Name:ATHLETIX REHAB AND RECOVERY DEERFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUPA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:570-574-7517
Mailing Address - Street 1:6941 SW 63RD CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3344
Mailing Address - Country:US
Mailing Address - Phone:570-574-7517
Mailing Address - Fax:
Practice Address - Street 1:1401 GREEN RD
Practice Address - Street 2:SUITE D/E/F
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:570-574-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty