Provider Demographics
NPI:1891753380
Name:FIT PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:FIT PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RINCON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-222-2082
Mailing Address - Street 1:1024 MISTLETOE LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0721
Mailing Address - Country:US
Mailing Address - Phone:530-222-2083
Mailing Address - Fax:530-222-8258
Practice Address - Street 1:1024 MISTLETOE LN
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0721
Practice Address - Country:US
Practice Address - Phone:530-222-2083
Practice Address - Fax:530-222-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32054ZMedicare ID - Type Unspecified