Formidable Physio & Fitness

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FORMIDABLE PHYSIO & FITNESS

Practice address

419 Dellwater Way
Spartanburg, SC 29306-5904

Phone

(864) 590-1867

NPI assigned

Oct 22, 2024

Last updated

Oct 22, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremiah Stout, DPT

Title

Owner/Physical Therapist

Phone

(864) 590-1867

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1073334090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 DELLWATER WAY",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293065904",
            "telephone_number": "864-590-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 DELLWATER WAY",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293065904",
            "telephone_number": "864-590-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMIDABLE PHYSIO & FITNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-22",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "JEREMIAH",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "864-590-1867",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Physical Therapy Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.