Provider Demographics
NPI:1033396817
Name:FIT FOR LIFE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:FIT FOR LIFE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-478-1933
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:CEDAR RIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95924-0010
Mailing Address - Country:US
Mailing Address - Phone:530-478-1933
Mailing Address - Fax:530-478-1937
Practice Address - Street 1:569 SEARLS AVE
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3003
Practice Address - Country:US
Practice Address - Phone:530-478-1933
Practice Address - Fax:530-478-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty