Mythical Fitness Trainers LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MYTHICAL FITNESS TRAINERS LLC

Doing business as

Fortitude Health and Performance

Practice address

4915 Lakepark Dr
Sanger, TX 76266-1406

Phone

(806) 215-4519

NPI assigned

Feb 20, 2021

Organization subpart

No

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

Authorized official

Name

Martin Tyler Martinez

Title

Physical Therapist Assitant

Phone

(806) 215-4519

Specialties & licenses 1

Addresses

Other names 1

• Fortitude Health and Performance Doing business as

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

{
    "created_epoch": "1613779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613779200000",
    "number": "1912591959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CAROLYN DR",
            "city": "SANGER",
            "state": "TX",
            "postal_code": "762669674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 LAKEPARK DR",
            "city": "SANGER",
            "state": "TX",
            "postal_code": "762661406",
            "telephone_number": "806-215-4519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYTHICAL FITNESS TRAINERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-20",
        "last_updated": "2021-02-20",
        "certification_date": "2021-02-20",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST ASSITANT",
        "authorized_official_telephone_number": "806-215-4519"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fortitude Health and Performance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charity Lujan, M.A. CCC-SLP
• Susan Marie Mackenzie, R.N., C.P.N., IBCLC
• Kristina Martinez, MS RD CSSD
• Michelle Ann McDonald
• Kelly Meredith, M.ED BCBA
• Neal Bhatt DMD PLLC
• New Hope Counseling PLLC
• Outstretched Arms LLC
• Outstretched Arms LLC (Red Bird Manor)
• Peak Physical Therapy, LLC

• Physical Therapy Clinic/Center in Sanger, TX
• Providers in Sanger, TX by specialty
• Physical Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2021; 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.