Provider Demographics
NPI:1881091791
Name:FITNESS FOR LIFE
Entity type:Organization
Organization Name:FITNESS FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL EXERCISE PHYSIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, RCEP
Authorized Official - Phone:256-509-5242
Mailing Address - Street 1:327 OLD HIGHWAY 431 STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35763
Mailing Address - Country:US
Mailing Address - Phone:256-509-5242
Mailing Address - Fax:256-715-0265
Practice Address - Street 1:327 OLD HIGHWAY 431 STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35763
Practice Address - Country:US
Practice Address - Phone:256-509-5242
Practice Address - Fax:256-715-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11945133V00000X, 225700000X, 224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty