Provider Demographics
NPI:1841596079
Name:KAN THERAPY LLC
Entity Type:Organization
Organization Name:KAN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESRAVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:954-558-1786
Mailing Address - Street 1:7627 OLD THYME CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3904
Mailing Address - Country:US
Mailing Address - Phone:954-558-1786
Mailing Address - Fax:
Practice Address - Street 1:7627 OLD THYME CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3904
Practice Address - Country:US
Practice Address - Phone:954-558-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty