Provider Demographics
NPI:1407932478
Name:KEN WRENCH PHYSICAL THERAPY, P/A
Entity Type:Organization
Organization Name:KEN WRENCH PHYSICAL THERAPY, P/A
Other - Org Name:ADVANCED PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-518-4677
Mailing Address - Street 1:13829 U.S. 98 BYPASS
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525
Mailing Address - Country:US
Mailing Address - Phone:352-518-4677
Mailing Address - Fax:352-518-4640
Practice Address - Street 1:13829 U.S. 98 BYPASS
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-518-4677
Practice Address - Fax:352-518-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0011588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3685Medicare ID - Type Unspecified
FLE5123Medicare ID - Type Unspecified