Provider Demographics
NPI:1275314924
Name:FIT PT GYM, INC.
Entity Type:Organization
Organization Name:FIT PT GYM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-723-0132
Mailing Address - Street 1:580 CYPRESS ST STE N2
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2670
Mailing Address - Country:US
Mailing Address - Phone:805-723-0132
Mailing Address - Fax:
Practice Address - Street 1:580 CYPRESS ST STE N2
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2670
Practice Address - Country:US
Practice Address - Phone:805-723-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy