NPIMap

Organization Active NPI

Kellen Ryan Scantlebury Physical Therapy PLLC

Doing business as Fit Club NY

  • Physical Therapy Clinic/Center
  • Astoria, NY
National Provider Identifier
1659148807
Registry record updated Sep 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
KELLEN RYAN SCANTLEBURY PHYSICAL THERAPY PLLC
Doing business as
Fit Club NY
Practice address
2103 31St Ave
Astoria, NY 11106-4521
Phone
(646) 875-8348
Fax
(212) 627-2048
NPI assigned
Dec 7, 2023
Last updated
Sep 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2024

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

Authorized official

Name
Dr. Kellen Scantlebury, DPTNPI 1326477498
Title
President
Phone
(516) 849-7989

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 Primary

Addresses

Primary practice location

2103 31St Ave
Astoria, NY 11106-4521

Mailing address

2103 31St Ave
Astoria, NY 11106-4521

Other practice location 1

257 Water Street
Brooklyn, NY 11201
Phone (646) 875-8348

Other practice location 2

153 W 27th St Ste 1204
New York, NY 10001-6250
Phone (646) 875-8348

Other practice location 3

203 Berry St
Brooklyn, NY 11249-3114
Phone (646) 875-8348

Other names 1

  • Fit Club NY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250206000182 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8325578339 Receives reassigned benefits from 7 practitioners
Practice locations: Astoria, NY; Brooklyn, NY; New York, NY

National Provider Directory

National Provider Directory
Tax ID family
Fit Club Ny2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

257 Water St
Brooklyn, NY 11201
Phone (646) 875-8348

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725753600000",
    "number": "1659148807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 31ST AVE",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111064521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 31ST AVE",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111064521",
            "telephone_number": "646-875-8348",
            "fax_number": "212-627-2048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "257 Water Street",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11201",
            "country_code": "US",
            "telephone_number": "646-875-8348",
            "fax_number": "212-627-2048",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "153 W 27th St Ste 1204",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100016250",
            "country_code": "US",
            "telephone_number": "646-875-8348",
            "fax_number": "212-627-2048",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "203 Berry St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112493114",
            "country_code": "US",
            "telephone_number": "646-875-8348",
            "fax_number": "212-627-2048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KELLEN RYAN SCANTLEBURY PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-07",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A",
        "authorized_official_last_name": "SCANTLEBURY",
        "authorized_official_first_name": "KELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-849-7989",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fit Club NY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fit Club NY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Astoria, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2024; 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.