Provider Demographics
NPI:1407509805
Name:FIXIDFITNESS
Entity Type:Organization
Organization Name:FIXIDFITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RADLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPT, CES,
Authorized Official - Phone:715-514-0242
Mailing Address - Street 1:120 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5325
Mailing Address - Country:US
Mailing Address - Phone:715-514-0242
Mailing Address - Fax:
Practice Address - Street 1:120 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5325
Practice Address - Country:US
Practice Address - Phone:715-514-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date: