Provider Demographics
NPI:1780964791
Name:FOUNDATION FITNESS OF ANNANDALE
Entity type:Organization
Organization Name:FOUNDATION FITNESS OF ANNANDALE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-909-7838
Mailing Address - Street 1:7060 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3104
Mailing Address - Country:US
Mailing Address - Phone:703-916-8782
Mailing Address - Fax:
Practice Address - Street 1:7060 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3104
Practice Address - Country:US
Practice Address - Phone:703-916-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty