Provider Demographics
NPI:1780629873
Name:REYNOLDS ROAD FITNESS CENTER INC.
Entity Type:Organization
Organization Name:REYNOLDS ROAD FITNESS CENTER INC.
Other - Org Name:SPORTS CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:SR VP
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7580
Mailing Address - Street 1:2865 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2068
Mailing Address - Country:US
Mailing Address - Phone:800-477-4035
Mailing Address - Fax:419-882-1352
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:800-477-4035
Practice Address - Fax:419-882-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366696Medicare ID - Type UnspecifiedMEDICARE PROVIDER #