Provider Demographics
NPI:1568103950
Name:LIFTED FITNESS AND WELLNESS LLC
Entity Type:Organization
Organization Name:LIFTED FITNESS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KRAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:931-216-5302
Mailing Address - Street 1:108 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-7881
Mailing Address - Country:US
Mailing Address - Phone:931-216-5302
Mailing Address - Fax:
Practice Address - Street 1:108 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-7881
Practice Address - Country:US
Practice Address - Phone:931-216-5302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty