Organization Active NPI

Fit and Fruitful, LLC

  • Physical Therapist
  • Anderson, SC
National Provider Identifier
1679317168
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FIT AND FRUITFUL, LLC
Practice address
102 Buford Ave Ste E
Anderson, SC 29621-3365
Phone
(908) 477-1598
NPI assigned
Jun 20, 2024
Last updated
Jun 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Authorized official

Name
Dr. Kendal Imani Anderson, DPTNPI 1598396640
Title
Owner
Phone
(908) 477-1598

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

102 Buford Ave Ste E
Anderson, SC 29621-3365

Mailing address

304 Keith Ave
Anderson, SC 29625-1811
Phone (908) 477-1598

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241004000987 SC Part B Supplier - Clinic/Group Practice 9234660978 Receives reassigned benefits from 1 practitioner
Practice locations: Anderson, SC

National Provider Directory

National Provider Directory

Locations

102 Buford Ave
Ste E
Anderson, SC 29621
Phone (864) 214-4431

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1679317168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 KEITH AVE",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296251811",
            "telephone_number": "908-477-1598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 BUFORD AVE STE E",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296213365",
            "telephone_number": "908-477-1598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIT AND FRUITFUL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "KENDAL",
        "authorized_official_middle_name": "IMANI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-477-1598",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.