NPIMap

Organization Active NPI

Club 50, LLC

Doing business as Fyzical

  • Physical Therapy Clinic/Center
  • Sarasota, FL
National Provider Identifier
1386034825
Registry record updated Nov 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
990010114743 Issued in FL
Legal business name
CLUB 50, LLC
Doing business as
Fyzical
Fyzical Therapy and Balance Center
Practice address
1727 2ND St Ste 2
Sarasota, FL 34236-8524
Phone
(941) 951-0170
Fax
(941) 993-1088
NPI assigned
Feb 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2018

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

Authorized official

Name
Keefe Charles Fugleberg, P.T.NPI 1790760924
Title
Owner
Phone
(941) 951-0170

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 990010114743 FL Primary

Addresses

Primary practice location

1727 2ND St Ste 2
Sarasota, FL 34236-8524

Mailing address

1727 2ND St Ste 2
Sarasota, FL 34236-8524
Phone (941) 951-0170

Other names 2

  • Fyzical Doing business as
  • Fyzical Therapy and Balance Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150407000842 FL Part B Supplier - Clinic/Group Practice 4789902578 Receives reassigned benefits from 12 practitioners
Practice locations: Sarasota, FL

National Provider Directory

National Provider Directory

Locations

1599 Main St
Sarasota, FL 34236
Phone (941) 951-0170

1727 2nd St
Ste 2
Sarasota, FL 34236
Phone (941) 951-0170

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542672000000",
    "number": "1386034825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 2ND ST STE 2",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342368524",
            "telephone_number": "941-951-0170",
            "fax_number": "941-993-1088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 2ND ST STE 2",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342368524",
            "telephone_number": "941-951-0170",
            "fax_number": "941-993-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB 50, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2018-11-20",
        "status": "A",
        "authorized_official_last_name": "FUGLEBERG",
        "authorized_official_first_name": "KEEFE",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-951-0170",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "990010114743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fyzical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fyzical Therapy and Balance Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sarasota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.