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General NPI Number Information
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NPI Number | 1972771673
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL FITNESS L L C
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 1185 S ADAMS RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7101
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Country | US
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Telephone | 248-988-8098
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Fax | 248-988-8583
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Provider Business Mailing Address
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Address Line | 1185 S ADAMS RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY HALE
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Credential |
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Telephone | 248-988-8098
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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