MEDICARE: FIZER FITNESS 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	261QP2000X	Physical Therapy Clinic/Center	PT 8496	FL

General Provider Information

NPI Number	:	1205061009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIZER FITNESS INC

Provider Business Mailing Address
First Line	:	3 TURTLEBACK TRL
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2564
Country	:	US
Telephone Number	:	904-280-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 TURTLEBACK TRL
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2564
Country	:	US
Telephone Number	:	904-280-4312
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PHYSICAL THERAPIST
Name	:	MS. JODI FIZER
Credential	:	P.T.
Telephone Number	:	904-280-4312

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	05/21/2009

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