Provider Demographics
NPI:1699450205
Name:FITLIFE TRAINING LLC
Entity type:Organization
Organization Name:FITLIFE TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-835-9386
Mailing Address - Street 1:9919 KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1117
Mailing Address - Country:US
Mailing Address - Phone:773-835-9386
Mailing Address - Fax:
Practice Address - Street 1:90 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3054
Practice Address - Country:US
Practice Address - Phone:773-835-9386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy