Provider Demographics
NPI:1821254079
Name:LIFE FITNESS THERAPY LLC
Entity Type:Organization
Organization Name:LIFE FITNESS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-769-0818
Mailing Address - Street 1:5438 ODONOVAN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4364
Mailing Address - Country:US
Mailing Address - Phone:225-769-0818
Mailing Address - Fax:225-769-0819
Practice Address - Street 1:5438 ODONOVAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4364
Practice Address - Country:US
Practice Address - Phone:225-769-0818
Practice Address - Fax:225-769-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03638F261QP2000X
LAPT01345F261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy