Medical Fitness Center LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1883 Issued in ID

Legal business name

MEDICAL FITNESS CENTER LLC

Practice address

1396 E Iron Eagle Dr Ste 100
Eagle, ID 83616-6620

Phone

(208) 870-3350

Fax

(208) 870-3350

NPI assigned

Jan 17, 2018

Organization subpart

No

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

Authorized official

Name

Benjamin Shatto, PT

Title

Owner

Phone

(208) 870-3350

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1516147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521590400000",
    "number": "1972011443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 E CONNER ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836463681",
            "telephone_number": "208-870-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1396 E IRON EAGLE DR STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166620",
            "telephone_number": "208-870-3350",
            "fax_number": "208-870-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL FITNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-17",
        "last_updated": "2018-03-21",
        "status": "A",
        "authorized_official_last_name": "SHATTO",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-870-3350",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT1883",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan Wallace McInnes Jr., M.D.
• Kylee A McManus
• Kathryn L McMullan, M.D.
• Jennifer McWaters, PSY.D.
• Mederx, LLC
• Mednow Inc (MedNow Eagle Pharmacy)
• Megan Meduna, MSPT
• Bethany Joy Mello, NP-C
• Lindsey Mepham
• Jordan W Merrill, MD

• Physical Therapist in Eagle, ID
• Providers in Eagle, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; 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.