Basic Information
| Provider Information | |||||||||
| NPI: | 1992106843 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FUNCTIONAL INTEGRATIVE TRAINING & CONTRACT SERVICES, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | F.I.T CONTRACT SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5006 CENTER ST | ||||||||
| Address2: | STE N | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984092314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534760449 | ||||||||
| FaxNumber: | 2534760286 | ||||||||
| Practice Location | |||||||||
| Address1: | 5006 CENTER ST | ||||||||
| Address2: | STE N | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984092314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534760449 | ||||||||
| FaxNumber: | 2534760286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 09/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | LETA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 2532121718 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.