Provider Demographics
NPI:1720156680
Name:FITNESS FOCUS, INC.
Entity type:Organization
Organization Name:FITNESS FOCUS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MAIXNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:651-429-9947
Mailing Address - Street 1:688 WILDWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-2060
Mailing Address - Country:US
Mailing Address - Phone:651-429-9947
Mailing Address - Fax:651-429-1029
Practice Address - Street 1:688 WILDWOOD ROAD
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115-2060
Practice Address - Country:US
Practice Address - Phone:651-429-9947
Practice Address - Fax:651-429-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4723261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy