MEDICARE: FIT 4 GOLF, LLC DBA ADVANCED PHYSICAL THERAPY AND MASSAGE

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1760670426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT 4 GOLF, LLC DBA ADVANCED PHYSICAL THERAPY AND MASSAGE

Provider Business Mailing Address
First Line	:	359 N 1ST AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-3618
Country	:	US
Telephone Number	:	319-350-9616
Fax Number	:	319-624-5273

Provider Business Practice Location Address
First Line	:	359 N 1ST AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-3618
Country	:	US
Telephone Number	:	319-350-9616
Fax Number	:	319-624-5273

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SUE ELLEN BRANSKY
Credential	:	P.T.
Telephone Number	:	319-350-9616

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	03/05/2012

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