Healthcare Provider Details

I. General information

NPI: 1598088536
Provider Name (Legal Business Name): FIT TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 S AMMON RD
AMMON ID
83406-6849
US

IV. Provider business mailing address

3544 E 17TH ST SUITE 203
AMMON ID
83406-6913
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-7993
  • Fax:
Mailing address:
  • Phone: 208-523-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD NEBEKER
Title or Position: MANAGING PARTNER
Credential:
Phone: 208-523-7993