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General NPI Number Information
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NPI Number | 1760884787
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Entity Type | Organization
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Legal Business Name | FIT FOR YOUR LIFE PHYSICAL THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 21675 E MILL RIVER LN
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-7696
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Country | US
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Telephone | 509-990-4583
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Fax |
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Provider Business Mailing Address
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Address Line | 21675 E MILL RIVER LN
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-7696
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Country | US
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Telephone | 509-990-4583
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAULA M STILES
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Credential | DPT
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Telephone | 509-990-4583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00008225
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License Number State | WA
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