Provider Demographics
NPI:1386309276
Name:MEDICAL FITNESS CLINIC OF KERRVILLE
Entity type:Organization
Organization Name:MEDICAL FITNESS CLINIC OF KERRVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CEP
Authorized Official - Phone:210-569-4129
Mailing Address - Street 1:1007 RIVER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063-5979
Mailing Address - Country:US
Mailing Address - Phone:210-569-4129
Mailing Address - Fax:
Practice Address - Street 1:1337 BANDERA HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9555
Practice Address - Country:US
Practice Address - Phone:210-569-4129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty