Provider Demographics
NPI:1790282721
Name:PERFECTLY FIT WELLNESS, LLC
Entity Type:Organization
Organization Name:PERFECTLY FIT WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:978-621-3948
Mailing Address - Street 1:1055 GRAND CONCOURSE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8827
Mailing Address - Country:US
Mailing Address - Phone:978-621-3948
Mailing Address - Fax:
Practice Address - Street 1:1476 BEN SAWYER BLVD STE 10
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4587
Practice Address - Country:US
Practice Address - Phone:843-509-2577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6585261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy