Provider Demographics
NPI:1144203894
Name:FIT FOR LIFE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:FIT FOR LIFE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAAF
Authorized Official - Middle Name:LAMBERT
Authorized Official - Last Name:VAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-642-1990
Mailing Address - Street 1:PO BOX 357279
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7279
Mailing Address - Country:US
Mailing Address - Phone:352-224-1963
Mailing Address - Fax:352-373-6112
Practice Address - Street 1:3919 W NEWBERRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2355
Practice Address - Country:US
Practice Address - Phone:352-373-7984
Practice Address - Fax:352-332-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891054500Medicaid
FL891054500Medicaid