Provider Demographics
NPI:1992323067
Name:FREEDOM PHYSICAL THERAPY & FITNESS
Entity type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:210-428-7845
Mailing Address - Street 1:7601 FOREST VALE
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-7217
Mailing Address - Country:US
Mailing Address - Phone:607-759-3792
Mailing Address - Fax:
Practice Address - Street 1:11471 E LOOP 1604 N STE 101
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3960
Practice Address - Country:US
Practice Address - Phone:210-428-7845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy