MEDICARE: MAKING FIT FUN, 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	174H00000X	Health Educator	PT7801	CA

General Provider Information

NPI Number	:	1932468956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKING FIT FUN, INC.

Provider Business Mailing Address
First Line	:	1605 W REDONDO BEACH BLVD
Second Line	:	STE. 201
City	:	GARDENA
State	:	CA
Zip	:	90247-3227
Country	:	US
Telephone Number	:	310-748-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 W REDONDO BEACH BLVD
Second Line	:	STE. 201
City	:	GARDENA
State	:	CA
Zip	:	90247-3227
Country	:	US
Telephone Number	:	310-748-8662
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPY MANAGER
Name	:	SONDRA K WYMAN
Credential	:
Telephone Number	:	310-748-8662

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	05/11/2012

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Directions to “MAKING FIT FUN, INC. ” Practice Location

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