Healthcare Provider Details

I. General information

NPI: 1851787980
Provider Name (Legal Business Name): FIT TECHNOLOGIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 E 17TH ST SUITE 201
AMMON ID
83406-6911
US

IV. Provider business mailing address

3544 E 17TH ST SUITE 201
AMMON ID
83406-6911
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-0685
  • Fax: 208-524-0686
Mailing address:
  • Phone: 208-524-0685
  • Fax: 208-524-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON BLUEMEL
Title or Position: OWNER
Credential:
Phone: 208-524-0685