Provider Demographics
NPI:1245605575
Name:PROFOUND FITNESS, LLC
Entity Type:Organization
Organization Name:PROFOUND FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-917-1525
Mailing Address - Street 1:7721 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021
Mailing Address - Country:US
Mailing Address - Phone:303-431-1642
Mailing Address - Fax:
Practice Address - Street 1:7721 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-431-1642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3327701251C00000X
3327701251C00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty