Provider Demographics
NPI:1043230527
Name:FITNESS PHILOSOPHY, LLC
Entity Type:Organization
Organization Name:FITNESS PHILOSOPHY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-223-9985
Mailing Address - Street 1:23067 VENTURA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1150
Mailing Address - Country:US
Mailing Address - Phone:818-223-9985
Mailing Address - Fax:818-223-9986
Practice Address - Street 1:23067 VENTURA BLVD STE A
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1150
Practice Address - Country:US
Practice Address - Phone:818-223-9985
Practice Address - Fax:818-223-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT3035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58760ZOtherBLUE SHIELD PROVIDER #
CAZZZ58760ZOtherBLUE SHIELD PROVIDER #