Provider Demographics
NPI:1568940906
Name:SWAMP FITNESS, LLC
Entity Type:Organization
Organization Name:SWAMP FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-562-0444
Mailing Address - Street 1:2345 NW 54TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2009
Mailing Address - Country:US
Mailing Address - Phone:954-907-4964
Mailing Address - Fax:
Practice Address - Street 1:2345 NW 54TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-2009
Practice Address - Country:US
Practice Address - Phone:352-562-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty