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General NPI Number Information
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NPI Number | 1912437583
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL FITNESS LLC
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4790 CAUGHLIN PKWY # 525
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City | RENO
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State | NV
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Zip | 89519-0907
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Country | US
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Telephone | 775-622-8034
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Fax |
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Provider Business Mailing Address
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Address Line | 4790 CAUGHLIN PKWY # 525
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City | RENO
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State | NV
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Zip | 89519-0907
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Country | US
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Telephone | 775-622-8034
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Fax |
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | SUZANNE LUCAS
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Credential | NASM, IDEA, CPT
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Telephone | 775-622-8034
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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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