Provider Demographics
NPI:1760106165
Name:HOLD FAST PERFORMANCE & WELLNESS
Entity Type:Organization
Organization Name:HOLD FAST PERFORMANCE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESORBO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, AT, ATC, CSCS
Authorized Official - Phone:419-482-8244
Mailing Address - Street 1:7224 HUNTERS CHASE
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9250
Mailing Address - Country:US
Mailing Address - Phone:952-240-1853
Mailing Address - Fax:
Practice Address - Street 1:13000 ECKEL JUNCTION RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1311
Practice Address - Country:US
Practice Address - Phone:419-482-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty