Provider Demographics
NPI:1164820973
Name:PROACTFIT, LLC
Entity Type:Organization
Organization Name:PROACTFIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICOLENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BODDIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, CSCS
Authorized Official - Phone:781-413-6103
Mailing Address - Street 1:892 PLAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:892 PLAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2191
Practice Address - Country:US
Practice Address - Phone:781-413-6103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18223261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy