Provider Demographics
NPI:1841448230
Name:LIFE FITNESS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LIFE FITNESS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:6914 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1747
Mailing Address - Country:US
Mailing Address - Phone:410-284-5441
Mailing Address - Fax:410-284-5442
Practice Address - Street 1:6914 HOLABIRD AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1747
Practice Address - Country:US
Practice Address - Phone:410-284-5441
Practice Address - Fax:410-284-5442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE FITNESS PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-28
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6524030002Medicare NSC
MD008NMedicare PIN