Provider Demographics
NPI:1619414661
Name:ADVANCED FITNESS & THERAPY
Entity Type:Organization
Organization Name:ADVANCED FITNESS & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT RECOVERY SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-639-8761
Mailing Address - Street 1:1200 UNIVERSITY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5215
Mailing Address - Country:US
Mailing Address - Phone:541-639-8761
Mailing Address - Fax:
Practice Address - Street 1:1200 UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5215
Practice Address - Country:US
Practice Address - Phone:541-639-8761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407143050Medicaid
FL1013988690Medicaid
FL1679811517Medicaid
FL1013988690Medicare NSC
FL1013988690Medicare UPIN
FL1407143050Medicaid
FL1407143050Medicare PIN
FL1679811517Medicare UPIN
FL1013988690Medicare Oscar/Certification
FL1407143050Medicare Oscar/Certification
FL1407143050Medicare NSC
FL1679811517Medicare PIN
FL1013988690Medicaid
FL1679811517Medicare Oscar/Certification
FL1407143050Medicare UPIN