Provider Demographics
NPI:1053837385
Name:FORTIS FITNESS & REHABILITATION, LLC
Entity Type:Organization
Organization Name:FORTIS FITNESS & REHABILITATION, LLC
Other - Org Name:EMPOWER MEDICAL PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:702-493-6473
Mailing Address - Street 1:1483 W HORIZON RIDGE PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4201
Mailing Address - Country:US
Mailing Address - Phone:702-899-3112
Mailing Address - Fax:
Practice Address - Street 1:1483 W HORIZON RIDGE PKWY STE 170
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012
Practice Address - Country:US
Practice Address - Phone:702-899-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2299261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy