Healthcare Provider Details

I. General information

NPI: 1003636812
Provider Name (Legal Business Name): FOREVER FIT PHYSICAL THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DEFENSE HWY STE 202
CROFTON MD
21114-2927
US

IV. Provider business mailing address

PO BOX 356
BURTONSVILLE MD
20866-0356
US

V. Phone/Fax

Practice location:
  • Phone: 301-783-0007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTA R FREDERIC
Title or Position: OWNER
Credential: PT, MPT
Phone: 301-421-1125