Provider Demographics
NPI:1801030978
Name:BAY AREA FITNESS AND PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BAY AREA FITNESS AND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:VECCHIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-921-8320
Mailing Address - Street 1:4203 EDENROCK PL
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6913
Mailing Address - Country:US
Mailing Address - Phone:617-921-8320
Mailing Address - Fax:
Practice Address - Street 1:4203 EDENROCK PL
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6913
Practice Address - Country:US
Practice Address - Phone:617-921-8320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21073261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy