Provider Demographics
NPI:1760157952
Name:FITNESS FORWARD LLC
Entity Type:Organization
Organization Name:FITNESS FORWARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-335-0839
Mailing Address - Street 1:17110 W GREENFIELD AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6947
Mailing Address - Country:US
Mailing Address - Phone:315-335-0839
Mailing Address - Fax:
Practice Address - Street 1:17110 W GREENFIELD AVE STE 7
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6947
Practice Address - Country:US
Practice Address - Phone:315-335-0839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy