Provider Demographics
NPI:1134893142
Name:EDUCATED ATHLETICS LTD.
Entity type:Organization
Organization Name:EDUCATED ATHLETICS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:949-701-6722
Mailing Address - Street 1:7044 PARROT BAY WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4748
Mailing Address - Country:US
Mailing Address - Phone:949-701-6722
Mailing Address - Fax:
Practice Address - Street 1:7044 PARROT BAY WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4748
Practice Address - Country:US
Practice Address - Phone:949-701-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy