Provider Demographics
NPI:1144837154
Name:FIT FOR LIFE PHYSICAL THERAY, LLC
Entity type:Organization
Organization Name:FIT FOR LIFE PHYSICAL THERAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:978-767-3271
Mailing Address - Street 1:59 BLUFFS DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03303-1579
Mailing Address - Country:US
Mailing Address - Phone:978-767-3271
Mailing Address - Fax:
Practice Address - Street 1:41 TERRILL PARK DR UNIT A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5258
Practice Address - Country:US
Practice Address - Phone:978-767-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy