Provider Demographics
NPI:1609421502
Name:FORTITUDE, INC
Entity Type:Organization
Organization Name:FORTITUDE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:TAYLOR SMITH
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:907-283-3340
Mailing Address - Street 1:49066 HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6112
Mailing Address - Country:US
Mailing Address - Phone:907-290-9973
Mailing Address - Fax:
Practice Address - Street 1:43900 KENAI SPUR HWY UNIT C
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9708
Practice Address - Country:US
Practice Address - Phone:907-283-3340
Practice Address - Fax:907-283-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty