Provider Demographics
NPI:1679317168
Name:FIT AND FRUITFUL, LLC
Entity type:Organization
Organization Name:FIT AND FRUITFUL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDAL
Authorized Official - Middle Name:IMANI
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:908-477-1598
Mailing Address - Street 1:304 KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-1811
Mailing Address - Country:US
Mailing Address - Phone:908-477-1598
Mailing Address - Fax:
Practice Address - Street 1:102 BUFORD AVE STE E
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3365
Practice Address - Country:US
Practice Address - Phone:908-477-1598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty