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General NPI Number Information
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NPI Number | 1063974152
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Entity Type | Organization
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Legal Business Name | FEARLESS FUNCTIONAL FITNESS, LLC
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 324 RIVERWALK DR STE 312
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City | SAN MARCOS
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State | TX
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Zip | 78666-6936
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Country | US
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Telephone | 512-268-9130
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Fax | 833-437-4389
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Provider Business Mailing Address
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Address Line | 324 RIVERWALK DR STE 312
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City | SAN MARCOS
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State | TX
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Zip | 78666-6936
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Country | US
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Telephone | 512-268-9130
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Fax | 833-437-4389
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. NICOLE ELIZABETH LAIRD
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Credential | PT, DPT
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Telephone | 512-730-9600
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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