MEDICARE: ACTIVEFIT360 LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1134076573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVEFIT360 LLC

Provider Business Mailing Address
First Line	:	2227 SNOW CREEK RD
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4370
Country	:	US
Telephone Number	:	331-472-7451
Fax Number	:	331-226-0556

Provider Business Practice Location Address
First Line	:	3420 LACROSSE LN STE 121
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8279
Country	:	US
Telephone Number	:	331-472-7451
Fax Number	:	331-226-0556

Authorized Official
Title or Position	:	OWNER
Name	:	NIKITA GOYAL
Credential	:
Telephone Number	:	331-472-7451

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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