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General NPI Number Information
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NPI Number | 1043969264
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Entity Type | Organization
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Legal Business Name | LABORATORY FITNESS, LLC
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 401 DIVIDEND DR STE K
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1939
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Country | US
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Telephone | 678-506-1236
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Fax | 866-635-2795
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Provider Business Mailing Address
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Address Line | 401 DIVIDEND DR STE K
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1939
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Country | US
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Telephone | 678-506-1236
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Fax | 866-635-2795
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Authorized Official
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Title or Position | CEO
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Name | BRANDON HANNON
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Credential |
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Telephone | 678-506-1236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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