Provider Demographics
NPI:1003636812
Name:FOREVER FIT PHYSICAL THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:FOREVER FIT PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FREDERIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:301-421-1125
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 DEFENSE HWY STE 202
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2927
Practice Address - Country:US
Practice Address - Phone:301-783-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOREVER FIT PHYSICAL THERAPY & WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy