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Organization
KICK SOME MASS, LLC
Active
Organization
KICK SOME MASS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY ALLYN RUTERBUSCH (MEDICAL DIRECTOR)
(904) 505-0628
Entity
Organization
Contact information
Practice address
316 PARKRIDGE AVE, ORANGE PARK, FL 32065-7507
(904) 589-0750
Mailing address
316 PARKRIDGE AVE, ORANGE PARK, FL 32065-7507
(904) 589-0750
(904) 621-9300
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
2083A0100X
Aerospace Medicine Physician
—
—
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IP327A
PTAN
FL
Enumeration date
07/07/2015
Last updated
10/22/2025
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