MEDICARE: FIT FOR HOME, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1578217089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT FOR HOME, LLC

Provider Business Mailing Address
First Line	:	2049 BARBERRY AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-4179
Country	:	US
Telephone Number	:	970-270-4015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2049 BARBERRY AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-4179
Country	:	US
Telephone Number	:	970-270-4015
Fax Number	:

Authorized Official
Title or Position	:	SOLE MBR
Name	:	PAMELA S GIBBONS
Credential	:	PT
Telephone Number	:	970-270-4015

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	02/04/2022

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Directions to “FIT FOR HOME, LLC ” Practice Location

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