| Organization Name: | PHOENIX FITNESS, INC. |
| NPI Number: | 1134482979 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAWN HUNSBERGER (PRESIDENT AND CEO) |
| Mailing Address: | 1460 E Valley Rd Suite 221 Basalt |
| State: | CO US |
| Postal Code: | 816218411 |
| Phone Number: | 9705105121 |
| Fax Number: | 9705105122 |
| NPI Enumeration Date: | 06/18/2012 |
| NPI Last Update Date: | 06/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |