Organization
AGING FIT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYLA GILLIAM (MANAGER)
(269) 408-1990
Entity
Organization
Contact information
Practice address
2800 NILES RD, SAINT JOSEPH, MI 49085-3317
(269) 408-1990
Mailing address
2800 NILES RD, SAINT JOSEPH, MI 49085-3317
(269) 408-1990
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501008773
LICENSE NUMBER
MI
Enumeration date
04/23/2019
Last updated
08/28/2019
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