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
StateLicense IDTaxonomies
FLOT14978261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine