Provider Demographics
NPI:1972946291
Name:PHYSICAL THERAPY & FITNESS PLUS INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY & FITNESS PLUS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:231-592-0027
Mailing Address - Street 1:15200 220TH AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9233
Mailing Address - Country:US
Mailing Address - Phone:231-592-0027
Mailing Address - Fax:231-592-0723
Practice Address - Street 1:15200 220TH AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9233
Practice Address - Country:US
Practice Address - Phone:231-592-0027
Practice Address - Fax:231-592-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI550100276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI93480OtherCOFINITY
MI0007705563OtherAETNA