Provider Demographics
NPI:1114632502
Name:SENIORFITNESS ATX LLC
Entity Type:Organization
Organization Name:SENIORFITNESS ATX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:515-867-1107
Mailing Address - Street 1:201 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2101
Mailing Address - Country:US
Mailing Address - Phone:515-867-1107
Mailing Address - Fax:
Practice Address - Street 1:201 TOWER RD
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-2101
Practice Address - Country:US
Practice Address - Phone:515-867-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty