Provider Demographics
NPI:1508497215
Name:ATHLETE RESTORATION COMPANY, LLC
Entity Type:Organization
Organization Name:ATHLETE RESTORATION COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VOLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-899-8725
Mailing Address - Street 1:11899 BAYBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2107
Mailing Address - Country:US
Mailing Address - Phone:561-814-3474
Mailing Address - Fax:
Practice Address - Street 1:512 EVERNIA ST STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5702
Practice Address - Country:US
Practice Address - Phone:561-899-8725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty