1144797812 NPI number — SOUL TO SOUL YOGA, LLC

Table of content: (NPI 1144797812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144797812 NPI number — SOUL TO SOUL YOGA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUL TO SOUL YOGA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144797812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 WHEATFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLETCHER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28732-0829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-702-2035
Provider Business Mailing Address Fax Number:
949-695-3128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 4TH AVE W
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33702-3953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-702-2035
Provider Business Practice Location Address Fax Number:
949-695-3128
Provider Enumeration Date:
10/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ALBRIGHT
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
941-702-2035

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101963100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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