MEDICARE: FIT KIDS, INC.

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1174186845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT KIDS, INC.

Provider Business Mailing Address
First Line	:	3838 N CENTRAL AVE STE 1600
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1950
Country	:	US
Telephone Number	:	800-354-4881
Fax Number	:	602-926-2445

Provider Business Practice Location Address
First Line	:	7900 S JESSE OWENS PKWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6523
Country	:	US
Telephone Number	:	602-341-3527
Fax Number	:	602-341-3529

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	LATASHA PITTMAN
Credential	:
Telephone Number	:	800-354-4881

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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Directions to “FIT KIDS, INC. ” Practice Location

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