=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669926689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PILATES FITNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2016
-----------------------------------------------------
Last Update Date | 01/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4041 N HIGH ST STE 203D
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-314-5773
-----------------------------------------------------
Fax | 614-636-4582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4041 N HIGH ST STE 203D
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-584-9232
-----------------------------------------------------
Fax | 614-636-4582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PHYSICAL THERAPIST
-----------------------------------------------------
Name | KAREN L TAKASHIMA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 614-584-9232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PTO008090
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------