Provider Demographics
NPI:1760884787
Name:FIT FOR YOUR LIFE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:FIT FOR YOUR LIFE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:509-990-4583
Mailing Address - Street 1:21675 E MILL RIVER LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7696
Mailing Address - Country:US
Mailing Address - Phone:509-990-4583
Mailing Address - Fax:
Practice Address - Street 1:21675 E MILL RIVER LN
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7696
Practice Address - Country:US
Practice Address - Phone:509-990-4583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty