Healthcare Provider Details

I. General information

NPI: 1932160975
Provider Name (Legal Business Name): FIFTY N FIT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11719 MENAUL BLVD NE
ALBUQUERQUE NM
87112-1790
US

IV. Provider business mailing address

11801 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2420
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-8050
  • Fax: 505-343-8050
Mailing address:
  • Phone: 505-271-9616
  • Fax: 505-271-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE S FRASER
Title or Position: OWNER
Credential: PT
Phone: 505-271-9616