Provider Demographics
NPI:1700187507
Name:K&S PHYSICAL GROUP CORP
Entity Type:Organization
Organization Name:K&S PHYSICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-463-9167
Mailing Address - Street 1:4995 NW 72ND AVE
Mailing Address - Street 2:204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5643
Mailing Address - Country:US
Mailing Address - Phone:305-463-9167
Mailing Address - Fax:305-463-9168
Practice Address - Street 1:4995 NW 72ND AVE
Practice Address - Street 2:204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-5643
Practice Address - Country:US
Practice Address - Phone:305-463-9167
Practice Address - Fax:305-463-9168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25804273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit