Provider Demographics
NPI:1144500166
Name:FOUNDATION FITNESS OF GEORGETOWN
Entity type:Organization
Organization Name:FOUNDATION FITNESS OF GEORGETOWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LETELLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-981-0895
Mailing Address - Street 1:4380 MACARTHUR BLVD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2551
Mailing Address - Country:US
Mailing Address - Phone:202-506-4999
Mailing Address - Fax:
Practice Address - Street 1:4380 MACARTHUR BLVD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2551
Practice Address - Country:US
Practice Address - Phone:202-506-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDATION FITNESS OF ANNANDALE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty