NPIMap

Organization Active NPI

Laboratory Fitness, LLC

  • Physical Therapy Clinic/Center
  • Peachtree City, GA
National Provider Identifier
1043969264
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
LABORATORY FITNESS, LLC
Practice address
401 Dividend Dr Ste K
Peachtree City, GA 30269-1939
Phone
(678) 506-1236
Fax
(866) 635-2795
NPI assigned
Mar 23, 2022
Last updated
Jun 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brandon Hannon
Title
Ceo
Phone
(678) 506-1236

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

401 Dividend Dr Ste K
Peachtree City, GA 30269-1939

Mailing address

401 Dividend Dr Ste K
Peachtree City, GA 30269-1939
Phone (678) 506-1236

Other names 1

  • Lab Fit Physical Therapy and Wellness Center, LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240731002517 GA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 1052858628 Practice locations: Peachtree City, GA
O20240821000736 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1052858628 Receives reassigned benefits from 2 practitioners
Practice locations: Peachtree City, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043969264. Details of each certification follow.

  • CCN 116923 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 116923

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LABORATORY FITNESS, LLC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Oct 21, 2024
Last certification
Oct 21, 2024
Ownership / control type
Proprietary
Facility address
401 Dividend Drive Suite K
Peachtree City, GA 30269

National Provider Directory

National Provider Directory

Locations

1001 Moba Dr
Peachtree City, GA 30269

1001 Moba Dr
Ste A
Peachtree City, GA 30269
Phone (678) 506-1236

611 Highway 74 S
Ste 300
Peachtree City, GA 30269

401 Dividend Dr
Ste K
Peachtree Cty, GA 30269
Phone (678) 506-1236

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 46

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1043969264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 DIVIDEND DR STE K",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691939",
            "telephone_number": "678-506-1236",
            "fax_number": "866-635-2795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DIVIDEND DR STE K",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691939",
            "telephone_number": "678-506-1236",
            "fax_number": "866-635-2795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY FITNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-23",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "HANNON",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-506-1236"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lab Fit Physical Therapy and Wellness Center, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Peachtree City, GA

Sources for this page

Verify at the official NPI Registry.