Healthcare Provider Details

I. General information

NPI: 1750150264
Provider Name (Legal Business Name): FITNESS FORWARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 PLAZA DR STE 2
ANN ARBOR MI
48108-3617
US

IV. Provider business mailing address

3700 PLAZA DR STE 2
ANN ARBOR MI
48108-3617
US

V. Phone/Fax

Practice location:
  • Phone: 734-203-0726
  • 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: SAMANTHA DEERING
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 734-478-9403