Provider Demographics
NPI:1063446011
Name:COMPETITIVE FITNESS, LLC
Entity Type:Organization
Organization Name:COMPETITIVE FITNESS, LLC
Other - Org Name:COMPETITIVE FITNESS & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:208-665-7055
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-0758
Mailing Address - Country:US
Mailing Address - Phone:208-773-6400
Mailing Address - Fax:208-773-6800
Practice Address - Street 1:1321 W NORTHWOOD CENTER CT
Practice Address - Street 2:SUITE B
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4944
Practice Address - Country:US
Practice Address - Phone:208-665-7055
Practice Address - Fax:208-665-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1376017Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER