1144203894 NPI number — FIT FOR LIFE PHYSICAL THERAPY, INC

Table of content: (NPI 1144203894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144203894 NPI number — FIT FOR LIFE PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIT FOR LIFE PHYSICAL THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144203894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 357279
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32635-7279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-224-1963
Provider Business Mailing Address Fax Number:
352-373-6112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3919 W NEWBERRY RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-373-7984
Provider Business Practice Location Address Fax Number:
352-332-3812
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VAES
Authorized Official First Name:
GUSTAAF
Authorized Official Middle Name:
LAMBERT
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
352-642-1990

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 891054500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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