Provider Demographics
NPI:1881817021
Name:SO FIT LLC
Entity Type:Organization
Organization Name:SO FIT LLC
Other - Org Name:PURE AUSTIN FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMODOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-342-2200
Mailing Address - Street 1:4210 W BRAKER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5354
Mailing Address - Country:US
Mailing Address - Phone:512-342-2200
Mailing Address - Fax:512-342-0128
Practice Address - Street 1:4210 W BRAKER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5354
Practice Address - Country:US
Practice Address - Phone:512-342-2200
Practice Address - Fax:512-342-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126639261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy