Organization
MEDICAL FITNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN SHATTO PT (OWNER)
(208) 870-3350
Entity
Organization
Contact information
Practice address
1396 E IRON EAGLE DR STE 100, EAGLE, ID 83616-6620
(208) 870-3350
(208) 870-3350
Mailing address
2315 E CONNER ST, MERIDIAN, ID 83646-3681
(208) 870-3350
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1883
ID
225200000X
Physical Therapy Assistant
—
—
Other
Enumeration date
01/17/2018
Last updated
03/21/2018
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