MEDICARE: FITNESS FORUM PT

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1568899300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITNESS FORUM PT

Provider Business Mailing Address
First Line	:	4994 W SENECA TPKE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-2279
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4994 W SENECA TPKE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215-2279
Country	:	US
Telephone Number	:	315-469-5990
Fax Number	:

Authorized Official
Title or Position	:	DPR
Name	:	MR. ADAM L SHOPIRO
Credential	:
Telephone Number	:	315-469-5990

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	10/10/2013

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Directions to “FITNESS FORUM PT ” Practice Location

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