Organization
PHYSIOFIT PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY RUSSELL (MANAGER)
(423) 238-8923
Entity
Organization
Contact information
Practice address
120 WHITE ROSE DR, RACELAND, LA 70394-2644
(985) 532-9662
(985) 532-3942
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
05/17/2013
Last updated
05/21/2013
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