Provider Demographics
NPI:1053610618
Name:FITNESS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FITNESS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHJEHAN
Authorized Official - Middle Name:ANWAR
Authorized Official - Last Name:JAURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-520-6860
Mailing Address - Street 1:2299 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1869
Mailing Address - Country:US
Mailing Address - Phone:248-520-6860
Mailing Address - Fax:248-706-1562
Practice Address - Street 1:6455 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1808
Practice Address - Country:US
Practice Address - Phone:313-921-8600
Practice Address - Fax:313-921-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy