MEDICARE: FIT CLUB 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	2251X0800X	Orthopedic Physical Therapist	037024	NY

General Provider Information

NPI Number	:	1225570807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT CLUB INC

Provider Business Mailing Address
First Line	:	3243 44TH ST APT 1F
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-2339
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 W 25TH ST
Second Line	:	GROUND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-7400
Country	:	US
Telephone Number	:	646-875-8348
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLEN SCANTLEBURY
Credential	:	PT, DPT, CSCS
Telephone Number	:	516-849-7989

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	11/14/2016

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Directions to “FIT CLUB INC ” Practice Location

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