1275564494 NPI number — ADVANCED FITNESS & THERAPY AT ABACOA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275564494 NPI number — ADVANCED FITNESS & THERAPY AT ABACOA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED FITNESS & THERAPY AT ABACOA, INC.
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:
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:
1275564494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-5215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-694-1243
Provider Business Mailing Address Fax Number:
561-694-8992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-694-1243
Provider Business Practice Location Address Fax Number:
561-694-8992
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUTIERREZ
Authorized Official First Name:
SOPHIE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
561-694-1243

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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