Provider Demographics
NPI:1134482979
Name:PHOENIX FITNESS, INC.
Entity Type:Organization
Organization Name:PHOENIX FITNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-510-5121
Mailing Address - Street 1:1460 E VALLEY RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8411
Mailing Address - Country:US
Mailing Address - Phone:970-510-5121
Mailing Address - Fax:970-510-5122
Practice Address - Street 1:1460 E VALLEY RD
Practice Address - Street 2:SUITE 221
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8411
Practice Address - Country:US
Practice Address - Phone:970-510-5121
Practice Address - Fax:970-510-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation