Provider Demographics
NPI:1538910047
Name:DEVYN KANGAS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DEVYN KANGAS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVYN
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:KANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:203-695-5688
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-0032
Mailing Address - Country:US
Mailing Address - Phone:203-695-5688
Mailing Address - Fax:229-631-5031
Practice Address - Street 1:6028 4-H CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-2772
Practice Address - Country:US
Practice Address - Phone:203-695-5688
Practice Address - Fax:229-632-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy