Provider Demographics
NPI:1992423032
Name:FREEPORT PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:FREEPORT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KALB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-603-3899
Mailing Address - Street 1:31 CANOPY CV
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-2330
Mailing Address - Country:US
Mailing Address - Phone:330-603-3899
Mailing Address - Fax:
Practice Address - Street 1:40 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-3505
Practice Address - Country:US
Practice Address - Phone:850-419-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy