Provider Demographics
NPI:1003491093
Name:BASTILLE FITNESS LLC
Entity Type:Organization
Organization Name:BASTILLE FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALESIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:609-209-1724
Mailing Address - Street 1:20 TERRY DR UNIT 1573
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4976
Mailing Address - Country:US
Mailing Address - Phone:267-991-8086
Mailing Address - Fax:
Practice Address - Street 1:13204 HARPERS XING
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:267-991-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care