Provider Demographics
NPI:1558849596
Name:NEUROFIT HEALTH PLLC
Entity Type:Organization
Organization Name:NEUROFIT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-779-1162
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86002-1150
Mailing Address - Country:US
Mailing Address - Phone:928-779-1162
Mailing Address - Fax:928-779-1163
Practice Address - Street 1:1200 N. BEAVER
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3118
Practice Address - Country:US
Practice Address - Phone:928-779-1162
Practice Address - Fax:928-779-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7036363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty