Provider Demographics
NPI:1134743396
Name:THE UNBROKEN ACADEMY LLC
Entity type:Organization
Organization Name:THE UNBROKEN ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:586-943-1717
Mailing Address - Street 1:3705 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3711
Mailing Address - Country:US
Mailing Address - Phone:586-943-1717
Mailing Address - Fax:
Practice Address - Street 1:2041 RIVER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1006
Practice Address - Country:US
Practice Address - Phone:586-943-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy