Provider Demographics
NPI:1578923975
Name:FOR LIFE HUMAN PERFORMANCE INC
Entity Type:Organization
Organization Name:FOR LIFE HUMAN PERFORMANCE INC
Other - Org Name:FOR LIFE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:TESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-878-3334
Mailing Address - Street 1:913 10TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9600
Mailing Address - Country:US
Mailing Address - Phone:605-878-3334
Mailing Address - Fax:605-878-0245
Practice Address - Street 1:913 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9600
Practice Address - Country:US
Practice Address - Phone:605-878-3334
Practice Address - Fax:605-878-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty