Provider Demographics
NPI:1124562863
Name:FOREVER FIT PHYSICAL THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:FOREVER FIT PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-421-1125
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0356
Mailing Address - Country:US
Mailing Address - Phone:301-681-7880
Mailing Address - Fax:
Practice Address - Street 1:10301 GEORGIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-681-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty