Provider Demographics
NPI:1699549105
Name:NEUROFIT, LLC
Entity type:Organization
Organization Name:NEUROFIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VISCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:410-967-4865
Mailing Address - Street 1:13 COOPERSTOWN CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1328
Mailing Address - Country:US
Mailing Address - Phone:410-967-4865
Mailing Address - Fax:
Practice Address - Street 1:13 COOPERSTOWN CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1328
Practice Address - Country:US
Practice Address - Phone:410-967-4865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD17696OtherPHYSICAL THERAPY LICENSE NUMBER