Provider Demographics
NPI:1316617285
Name:GET FIT BY JOURNEY INC
Entity type:Organization
Organization Name:GET FIT BY JOURNEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:THELWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-412-6453
Mailing Address - Street 1:4101 PARK LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5265
Mailing Address - Country:US
Mailing Address - Phone:407-412-6453
Mailing Address - Fax:
Practice Address - Street 1:4101 PARK LAKE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5265
Practice Address - Country:US
Practice Address - Phone:407-412-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1316617285Medicaid