Provider Demographics
NPI:1003053802
Name:PT EFIT LLC
Entity Type:Organization
Organization Name:PT EFIT LLC
Other - Org Name:PT@EFITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GANEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-392-0228
Mailing Address - Street 1:PO BOX 6157
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-6157
Mailing Address - Country:US
Mailing Address - Phone:228-392-0228
Mailing Address - Fax:228-392-0229
Practice Address - Street 1:1735 RICHARD DR
Practice Address - Street 2:ROOM 123B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-4400
Practice Address - Country:US
Practice Address - Phone:228-392-0228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0841261QP2000X
MSPT0926261QP2000X
MSPT0500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy