Healthcare Provider Details

I. General information

NPI: 1063501484
Provider Name (Legal Business Name): FITHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 GULF BLVD STE 116
ST PETE BEACH FL
33706-2454
US

IV. Provider business mailing address

PO BOX 468
ST PETERSBURG FL
33731-0468
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-0075
  • Fax: 727-367-0402
Mailing address:
  • Phone: 727-367-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberEXEMPTION# HCC1162
License Number StateFL

VIII. Authorized Official

Name: CAROL H HOLLENBECK
Title or Position: OWNER
Credential: P.T.
Phone: 727-365-6515