| Organization Name: | PHYSIOFIT PHYSICAL THERAPY, LLC |
| NPI Number: | 1386080323 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KILEY RUSSELL (MANAGER) |
| Mailing Address: | 120 White Rose Dr Raceland |
| State: | LA US |
| Postal Code: | 703942644 |
| Phone Number: | 9855329662 |
| Fax Number: | 9855323942 |
| NPI Enumeration Date: | 05/17/2013 |
| NPI Last Update Date: | 05/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |