Healthcare Provider Details

I. General information

NPI: 1669468427
Provider Name (Legal Business Name): FITNESS DESIGNS PHYSICAL THERAPY & SPORTS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 GINGER CREEK PKWY
GLEN CARBON IL
62034-3502
US

IV. Provider business mailing address

16 GINGER CREEK PKWY
GLEN CARBON IL
62034-3502
US

V. Phone/Fax

Practice location:
  • Phone: 618-656-1122
  • Fax: 618-656-1171
Mailing address:
  • Phone: 618-656-1122
  • Fax: 618-656-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. DAVID HAROLD STRICKFADEN
Title or Position: MANAGING PARTNER
Credential:
Phone: 618-656-1122