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General NPI Number Information
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NPI Number | 1760157952
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Entity Type | Organization
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Legal Business Name | FITNESS FORWARD LLC
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 17110 W GREENFIELD AVE STE 7
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City | BROOKFIELD
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State | WI
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Zip | 53005-6947
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Country | US
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Telephone | 315-335-0839
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Fax |
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Provider Business Mailing Address
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Address Line | 17110 W GREENFIELD AVE STE 7
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City | BROOKFIELD
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State | WI
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Zip | 53005-6947
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Country | US
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Telephone | 315-335-0839
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KELLY L BENFEY
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Credential | DPT
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Telephone | 315-335-0839
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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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