Provider Demographics
NPI:1760043798
Name:KRK THERAPY CENTER, INC
Entity Type:Organization
Organization Name:KRK THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JERONIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:COREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-873-6117
Mailing Address - Street 1:4148 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4107
Mailing Address - Country:US
Mailing Address - Phone:305-418-0336
Mailing Address - Fax:
Practice Address - Street 1:4176 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4158
Practice Address - Country:US
Practice Address - Phone:305-418-0336
Practice Address - Fax:305-456-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy