Provider Demographics
NPI:1669468427
Name:FITNESS DESIGNS PHYSICAL THERAPY & SPORTS REHAB
Entity Type:Organization
Organization Name:FITNESS DESIGNS PHYSICAL THERAPY & SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:STRICKFADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-656-1122
Mailing Address - Street 1:16 GINGER CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3502
Mailing Address - Country:US
Mailing Address - Phone:618-656-1122
Mailing Address - Fax:618-656-1171
Practice Address - Street 1:16 GINGER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3502
Practice Address - Country:US
Practice Address - Phone:618-656-1122
Practice Address - Fax:618-656-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL703470Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER