Provider Demographics
NPI:1609009224
Name:FITNESS PATHWAYS, LLC
Entity type:Organization
Organization Name:FITNESS PATHWAYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WYOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MC CRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-676-6746
Mailing Address - Street 1:18 PITZERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-6003
Mailing Address - Country:US
Mailing Address - Phone:304-676-6746
Mailing Address - Fax:
Practice Address - Street 1:18 PITZERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6003
Practice Address - Country:US
Practice Address - Phone:304-676-6746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty