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General NPI Number Information
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NPI Number | 1861960601
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL FITNESS OF DUPAGE, INC
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 27W157 WALNUT DR
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City | WINFIELD
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State | IL
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Zip | 60190-2051
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Country | US
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Telephone | 630-390-8417
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Fax |
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Provider Business Mailing Address
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Address Line | 27W157 WALNUT DR
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City | WINFIELD
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State | IL
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Zip | 60190-2051
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Country | US
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Telephone | 630-390-8417
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Fax |
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Authorized Official
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Title or Position | CLINICAL EXERCISE PHYSIOLOGIST
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Name | TANNER SHULTZ
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Credential | MS, CSCS
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Telephone | 630-390-8417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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