Provider Demographics
NPI:1568756757
Name:FIT CONSULTANTS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FIT CONSULTANTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MBA, ATC,
Authorized Official - Phone:866-484-8183
Mailing Address - Street 1:35111 SEAGRASS PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-3391
Mailing Address - Country:US
Mailing Address - Phone:866-484-8193
Mailing Address - Fax:888-516-4393
Practice Address - Street 1:35111 SEAGRASS PLANTATION LN
Practice Address - Street 2:
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939
Practice Address - Country:US
Practice Address - Phone:866-484-8193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-05
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT003408L261QM1300X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty