Provider Demographics
NPI:1881710192
Name:EXECUTIVE FITNESS INC
Entity type:Organization
Organization Name:EXECUTIVE FITNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SODER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:702-222-1000
Mailing Address - Street 1:6440 MEDICAL CENTER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2404
Mailing Address - Country:US
Mailing Address - Phone:702-222-1000
Mailing Address - Fax:702-222-9448
Practice Address - Street 1:6440 MEDICAL CENTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2404
Practice Address - Country:US
Practice Address - Phone:702-222-1000
Practice Address - Fax:702-222-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1000002-322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty