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General NPI Number Information
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NPI Number | 1821617804
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Entity Type | Organization
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Legal Business Name | FIT-MINDED, LLC
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 101 FORREST AVE
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City | NARBERTH
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State | PA
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Zip | 19072-2213
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Country | US
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Telephone | 610-716-8630
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Fax |
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Provider Business Mailing Address
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Address Line | 108 FORREST AVE APT 4
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City | NARBERTH
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State | PA
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Zip | 19072-2213
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Country | US
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Telephone | 610-716-8630
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. NORA J JOHNSON
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Credential | PSYD
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Telephone | 610-716-8630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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