Provider Demographics
NPI: | 1700280559 |
---|---|
Name: | KG THERAPY LLC |
Entity Type: | Organization |
Organization Name: | KG THERAPY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KASANDRA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GEHRING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTR/L |
Authorized Official - Phone: | 561-504-0315 |
Mailing Address - Street 1: | 1015 SPANISH RIVER RD |
Mailing Address - Street 2: | #304 |
Mailing Address - City: | BOCA RATON |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33432-7677 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-504-0315 |
Mailing Address - Fax: | 561-533-9918 |
Practice Address - Street 1: | 1015 SPANISH RIVER RD |
Practice Address - Street 2: | #304 |
Practice Address - City: | BOCA RATON |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33432-7677 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-504-0315 |
Practice Address - Fax: | 561-533-9918 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-10-22 |
Last Update Date: | 2014-11-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | OT14978 | 261QX0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |