Provider Demographics
NPI:1912437583
Name:FUNCTIONAL FITNESS LLC
Entity Type:Organization
Organization Name:FUNCTIONAL FITNESS LLC
Other - Org Name:ANYTIME FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:NASM, IDEA, CPT
Authorized Official - Phone:775-622-8034
Mailing Address - Street 1:4790 CAUGHLIN PKWY # 525
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0907
Mailing Address - Country:US
Mailing Address - Phone:775-622-8034
Mailing Address - Fax:
Practice Address - Street 1:4790 CAUGHLIN PKWY # 525
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0907
Practice Address - Country:US
Practice Address - Phone:775-622-8034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy