Provider Demographics
NPI:1760641500
Name:KZB
Entity Type:Organization
Organization Name:KZB
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSIONAL TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-577-2986
Mailing Address - Street 1:1114TH 16TH COURT SOUTH
Mailing Address - Street 2:
Mailing Address - City:PHENIX
Mailing Address - State:AL
Mailing Address - Zip Code:36869
Mailing Address - Country:US
Mailing Address - Phone:706-577-2986
Mailing Address - Fax:
Practice Address - Street 1:1114TH 16TH COURT SOUTH
Practice Address - Street 2:
Practice Address - City:PHENIX
Practice Address - State:AL
Practice Address - Zip Code:36869
Practice Address - Country:US
Practice Address - Phone:706-577-2986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120927251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare