Provider Demographics
NPI:1326193426
Name:SPARTA FIT FOR LIFE, LLC
Entity Type:Organization
Organization Name:SPARTA FIT FOR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-729-1222
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1930
Mailing Address - Country:US
Mailing Address - Phone:973-729-1222
Mailing Address - Fax:973-729-1220
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1930
Practice Address - Country:US
Practice Address - Phone:973-729-1222
Practice Address - Fax:973-729-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00648300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093377Medicare ID - Type UnspecifiedPRACTICE IDENTIFIER