MEDICARE: KNEAD TO BE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	322246	OTHER	FL	WELLCARE
2	696920	OTHER	FL	UHC
3	Y914V	OTHER	FL	BCBS
4	11362690	OTHER	FL	CAQH

General Provider Information

NPI Number	:	1699732438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNEAD TO BE FIT, INC

Provider Business Mailing Address
First Line	:	3160 SOUTHGATE COMMERCE BLVD
Second Line	:	SUITE 38B
City	:	ORLANDO
State	:	FL
Zip	:	32806-8549
Country	:	US
Telephone Number	:	321-251-7877
Fax Number	:	321-206-8212

Provider Business Practice Location Address
First Line	:	3160 SOUTHGATE COMMERCE BLVD
Second Line	:	SUITE 38B
City	:	ORLANDO
State	:	FL
Zip	:	32806-8549
Country	:	US
Telephone Number	:	321-251-7877
Fax Number	:	321-206-8212

Authorized Official
Title or Position	:	COO
Name	:	STEPHANIE KINGSTON
Credential	:
Telephone Number	:	321-251-7877

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/21/2015

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Directions to “KNEAD TO BE FIT, INC ” Practice Location

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