Healthcare Provider Details

I. General information

NPI: 1598916645
Provider Name (Legal Business Name): FIT SPORTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 N PENNSYLVANIA ST
CARMEL IN
46032
US

IV. Provider business mailing address

11900 N. PENNSYLVANIA ST. SUITE 203
CARMEL IN
46032
US

V. Phone/Fax

Practice location:
  • Phone: 317-679-2809
  • Fax: 317-569-8572
Mailing address:
  • Phone: 317-679-2809
  • Fax: 317-569-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number05001715A
License Number StateIN

VIII. Authorized Official

Name: MR. BRADLEY A SMITH
Title or Position: PRESIDENT
Credential: P.T.
Phone: 317-679-2809