Provider Demographics
NPI:1891540613
Name:FACILITATED FITNESS LLC
Entity type:Organization
Organization Name:FACILITATED FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CLEMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:423-218-9703
Mailing Address - Street 1:106 WILLOCKS RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-6274
Mailing Address - Country:US
Mailing Address - Phone:423-218-9703
Mailing Address - Fax:
Practice Address - Street 1:106 WILLOCKS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-6274
Practice Address - Country:US
Practice Address - Phone:423-218-9703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty