Provider Demographics
NPI:1710418835
Name:FIT LLC
Entity Type:Organization
Organization Name:FIT LLC
Other - Org Name:FUNCTIONAL INTEGRATED THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN-MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-370-0770
Mailing Address - Street 1:7318 N OPUNTA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6201
Mailing Address - Country:US
Mailing Address - Phone:520-370-0770
Mailing Address - Fax:
Practice Address - Street 1:7318 N OPUNTA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6201
Practice Address - Country:US
Practice Address - Phone:520-370-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty