=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962959189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | V-FIT FUNCTIONAL PHYSICAL THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2016
-----------------------------------------------------
Last Update Date | 09/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1433 BROADWAY UNIT 5
-----------------------------------------------------
City | HEWLETT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11557-1361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-351-2343
-----------------------------------------------------
Fax | 516-400-9997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 VINCENT AVE
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-351-2343
-----------------------------------------------------
Fax | 516-400-9997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | MR. VITO ANTHONY BOITS
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 516-351-2343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------