Healthcare Provider Details

I. General information

NPI: 1033162748
Provider Name (Legal Business Name): LIFEFITNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SISKIN PLZ
CHATTANOOGA TN
37403-1306
US

IV. Provider business mailing address

1 SISKIN PLZ
CHATTANOOGA TN
37403-1306
US

V. Phone/Fax

Practice location:
  • Phone: 423-634-1587
  • Fax: 423-634-4587
Mailing address:
  • Phone: 423-634-1587
  • Fax: 423-634-4587

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: MR. TOD CAIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 423-634-1648