Healthcare Provider Details

I. General information

NPI: 1821283581
Provider Name (Legal Business Name): THERA FIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8306 E 235TH ST
PECULIAR MO
64078-9267
US

IV. Provider business mailing address

8306 E 235TH ST
PECULIAR MO
64078-9267
US

V. Phone/Fax

Practice location:
  • Phone: 816-305-3469
  • Fax: 816-779-1054
Mailing address:
  • Phone: 816-305-3469
  • Fax: 816-779-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA S BIRKETT
Title or Position: GENERAL MANAGER
Credential: OTR
Phone: 816-305-3469