Provider Demographics
NPI:1598916645
Name:FIT SPORTS, LLC
Entity Type:Organization
Organization Name:FIT SPORTS, LLC
Other - Org Name:BROWN BAG MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-679-2809
Mailing Address - Street 1:11900 N. PENNSYLVANIA ST. SUITE 203
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-679-2809
Mailing Address - Fax:317-569-8572
Practice Address - Street 1:11900 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-679-2809
Practice Address - Fax:317-569-8572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001715A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1043312911OtherINDIVIDUAL PROVIDER, PHYSICAL THERAPIST