Provider Demographics
NPI:1336987908
Name:FIT FOR LIFE PHYSICAL THERAPY
Entity type:Organization
Organization Name:FIT FOR LIFE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ASIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-204-1240
Mailing Address - Street 1:1604 NE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2726
Mailing Address - Country:US
Mailing Address - Phone:360-204-1240
Mailing Address - Fax:
Practice Address - Street 1:3007 NE EMERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6905
Practice Address - Country:US
Practice Address - Phone:503-213-9423
Practice Address - Fax:503-210-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty