Provider Demographics
NPI:1821056805
Name:THE ULTIMATE HEALTH AND FITNESS, LLC
Entity Type:Organization
Organization Name:THE ULTIMATE HEALTH AND FITNESS, LLC
Other - Org Name:ULTIMATE HEALTH AND FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-238-3600
Mailing Address - Street 1:3171 S 3RD PL
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3785
Mailing Address - Country:US
Mailing Address - Phone:812-238-3600
Mailing Address - Fax:812-238-3677
Practice Address - Street 1:3171 S 3RD PL
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3785
Practice Address - Country:US
Practice Address - Phone:812-238-3600
Practice Address - Fax:812-238-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2008518050Medicaid
IN234680BMedicare ID - Type Unspecified