MEDICARE: FIT WITH FOOD 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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1235710294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT WITH FOOD LLC

Provider Business Mailing Address
First Line	:	19900 MIDDLETOWN RD
Second Line	:
City	:	FREELAND
State	:	MD
Zip	:	21053-9421
Country	:	US
Telephone Number	:	410-978-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	8388 COURT AVE STE 202
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4514
Country	:	US
Telephone Number	:	443-355-7021
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY FULTZ
Credential	:	MS, RD, LDN
Telephone Number	:	443-355-7021

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	04/20/2021

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Directions to “FIT WITH FOOD LLC ” Practice Location

Language	Start Address	Practice Location

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