MEDICARE: PERSONALLY FIT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1043390073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONALLY FIT INC

Provider Business Mailing Address
First Line	:	11501 RANCHO BERNARDO ROAD
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-1404
Country	:	US
Telephone Number	:	858-485-6706
Fax Number	:	858-405-7052

Provider Business Practice Location Address
First Line	:	11501 RANCHO BERNARDO ROAD
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-1404
Country	:	US
Telephone Number	:	858-485-6706
Fax Number	:	858-405-7052

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES FLOOD
Credential	:
Telephone Number	:	858-485-6706

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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Directions to “PERSONALLY FIT INC ” Practice Location

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