Healthcare Provider Details

I. General information

NPI: 1982020327
Provider Name (Legal Business Name): MIGHTY FIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14757 OAK RD 200
CARMEL IN
46033-8178
US

IV. Provider business mailing address

628 S 10TH ST
NOBLESVILLE IN
46060-3501
US

V. Phone/Fax

Practice location:
  • Phone: 317-385-1620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRANATO
Title or Position: OWNER
Credential:
Phone: 317-385-1620