Provider Demographics
NPI: | 1144784810 |
---|---|
Name: | FREDERICKSBURG FITNESS STUDIO |
Entity Type: | Organization |
Organization Name: | FREDERICKSBURG FITNESS STUDIO |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KORZEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | BS, CPT, MES, SSF |
Authorized Official - Phone: | 540-479-1877 |
Mailing Address - Street 1: | 2541 COWAN BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | FREDERICKSBURG |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22401-8440 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-479-1877 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2541 COWAN BLVD |
Practice Address - Street 2: | |
Practice Address - City: | FREDERICKSBURG |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22401-8440 |
Practice Address - Country: | US |
Practice Address - Phone: | 540-479-1877 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-01-28 |
Last Update Date: | 2019-01-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225400000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | Group - Single Specialty |