Provider Demographics
NPI:1205515202
Name:KRU PT AND PERFORMANCE LAB, LLC
Entity type:Organization
Organization Name:KRU PT AND PERFORMANCE LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUPA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CSCS
Authorized Official - Phone:570-574-7517
Mailing Address - Street 1:PO BOX 331004
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233-1004
Mailing Address - Country:US
Mailing Address - Phone:570-574-7517
Mailing Address - Fax:
Practice Address - Street 1:1401 GREEN RD STE DEF
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1080
Practice Address - Country:US
Practice Address - Phone:570-574-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRU PT AND PERFORMANCE LAB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty