1679148159 NPI number — REHABILITATION & FITNESS ASSOCIATES, INC.

Table of content: (NPI 1679148159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679148159 NPI number — REHABILITATION & FITNESS ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION & FITNESS ASSOCIATES, 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:
1679148159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
629 S PLUMMER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANUTE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66720-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-432-5378
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
629 S PLUMMER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-432-5378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LLIUDAHL
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
FTINESS MANAGER
Authorized Official Telephone Number:
620-432-5378

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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