Provider Demographics
NPI:1225601792
Name:FORTITUDE MOVEMENT & STRENGTH PLLC
Entity Type:Organization
Organization Name:FORTITUDE MOVEMENT & STRENGTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:KIRSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC, CSCS
Authorized Official - Phone:706-294-0170
Mailing Address - Street 1:2924 100TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9813
Mailing Address - Country:US
Mailing Address - Phone:425-205-0821
Mailing Address - Fax:
Practice Address - Street 1:2924 100TH AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9813
Practice Address - Country:US
Practice Address - Phone:425-205-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy