Provider Demographics
NPI:1245607696
Name:MONDO SPORTS THERAPY, LLC
Entity Type:Organization
Organization Name:MONDO SPORTS THERAPY, LLC
Other - Org Name:MONDO SPORTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:AUGUSTINUS
Authorized Official - Last Name:KROON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:512-422-4258
Mailing Address - Street 1:7109 SPURLOCK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2134
Mailing Address - Country:US
Mailing Address - Phone:512-422-4258
Mailing Address - Fax:
Practice Address - Street 1:4201 MARATHON BLVD STE 204
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3409
Practice Address - Country:US
Practice Address - Phone:512-422-4258
Practice Address - Fax:512-300-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty