Provider Demographics
NPI:1114324597
Name:FITNESS & FUNCTION LLC
Entity Type:Organization
Organization Name:FITNESS & FUNCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINKE
Authorized Official - Suffix:
Authorized Official - Credentials:HFS, PFT
Authorized Official - Phone:503-267-1030
Mailing Address - Street 1:4804 NW BETHANY BLVD
Mailing Address - Street 2:SUITE 12 #167
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9195
Mailing Address - Country:US
Mailing Address - Phone:503-267-1030
Mailing Address - Fax:503-488-5576
Practice Address - Street 1:4804 NW BETHANY BLVD
Practice Address - Street 2:SUITE 12 #167
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-9195
Practice Address - Country:US
Practice Address - Phone:503-267-1030
Practice Address - Fax:503-488-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty