Provider Demographics
NPI:1679036362
Name:VITALITY FITNESS AND WELLNESS LLC
Entity Type:Organization
Organization Name:VITALITY FITNESS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RAHMER
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:315-337-0821
Mailing Address - Street 1:8599 TURIN RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-7521
Mailing Address - Country:US
Mailing Address - Phone:315-337-0821
Mailing Address - Fax:
Practice Address - Street 1:8599 TURIN RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-7521
Practice Address - Country:US
Practice Address - Phone:315-337-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty