Provider Demographics
NPI:1649958471
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
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 1:3183 SW 38TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1528
Practice Address - Country:US
Practice Address - Phone:570-574-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty