Provider Demographics
NPI:1124105473
Name:FITLIFE FITNESS & AQUATICS, INCORPORATED
Entity type:Organization
Organization Name:FITLIFE FITNESS & AQUATICS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-282-4239
Mailing Address - Street 1:7140 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1843
Mailing Address - Country:US
Mailing Address - Phone:215-753-9034
Mailing Address - Fax:215-753-9035
Practice Address - Street 1:7140 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1843
Practice Address - Country:US
Practice Address - Phone:215-753-9034
Practice Address - Fax:215-753-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA186190261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063590Medicare ID - Type UnspecifiedPHYSICAL THERAPY PRACTICE