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General NPI Number Information
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NPI Number | 1407509805
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Entity Type | Organization
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Legal Business Name | FIXIDFITNESS
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 120 W GRAND AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5325
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Country | US
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Telephone | 715-514-0242
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W GRAND AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5325
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Country | US
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Telephone | 715-514-0242
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MEGAN ELIZABETH RADLE
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Credential | CPT, CES,
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Telephone | 715-514-0242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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