Fitness Center Physical Therapy

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

FITNESS CENTER PHYSICAL THERAPY

Practice address

425 Boardman Ave
Traverse City, MI 49684-2562

Phone

(231) 941-1800

Fax

(231) 941-7021

NPI assigned

Jan 30, 2007

Last updated

Aug 22, 2020By 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

Jeffrey W Holman

Title

President

Phone

(231) 941-1800

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528104114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 BOARDMAN AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842562",
            "telephone_number": "231-941-1800",
            "fax_number": "231-941-7021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 BOARDMAN AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842562",
            "telephone_number": "231-941-1800",
            "fax_number": "231-941-7021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITNESS CENTER PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-941-1800"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "30369",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karla A Fishburn, RN
• Brian R Fisher, DDS
• Daniel Robert Fisher, DDS
• Larissa Lynn Fisher, PA
• Chase Anthony Fitch
• Marylin Fitzgerald, M.A. LLP
• Alexandra Fitzgibbon, LMSW
• Chelsea Renell Fitzpatrick, RD
• Hailey Elizabeth Fitzpatrick
• Lisa Fitzpatrick, OTR/CHT,CAE,CEAS

• Physical Therapy Clinic/Center in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.