Basic Information
| Provider Information | |||||||||
| NPI: | 1063446011 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMPETITIVE FITNESS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPETITIVE FITNESS & PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 758 | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838770758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087736400 | ||||||||
| FaxNumber: | 2087736800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 W NORTHWOOD CENTER CT | ||||||||
| Address2: | SUITE B | ||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838144944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086657055 | ||||||||
| FaxNumber: | 2086657093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WEBER | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2086657055 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MS, PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-687 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.