Provider Demographics
NPI:1467947374
Name:GOFIT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GOFIT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:443-699-4771
Mailing Address - Street 1:406 DUCKBILL LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5489
Mailing Address - Country:US
Mailing Address - Phone:443-699-4771
Mailing Address - Fax:
Practice Address - Street 1:406 DUCKBILL LN
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5489
Practice Address - Country:US
Practice Address - Phone:443-699-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy