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General NPI Number Information
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NPI Number | 1134482979
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Entity Type | Organization
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Legal Business Name | PHOENIX FITNESS, INC.
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 1460 E VALLEY RD SUITE 221
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City | BASALT
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State | CO
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Zip | 81621-8411
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Country | US
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Telephone | 970-510-5121
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Fax | 970-510-5122
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Provider Business Mailing Address
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Address Line | 1460 E VALLEY RD SUITE 221
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City | BASALT
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State | CO
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Zip | 81621-8411
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Country | US
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Telephone | 970-510-5121
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Fax | 970-510-5122
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | SHAWN HUNSBERGER
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Credential |
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Telephone | 970-510-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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