Provider Demographics
NPI:1013395441
Name:LIFE FITNESS CENTER
Entity Type:Organization
Organization Name:LIFE FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSCARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-891-1411
Mailing Address - Street 1:411 HUKU LII PL
Mailing Address - Street 2:#302
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7062
Mailing Address - Country:US
Mailing Address - Phone:808-891-1411
Mailing Address - Fax:808-891-1422
Practice Address - Street 1:411 HUKU LII PL
Practice Address - Street 2:#302
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7062
Practice Address - Country:US
Practice Address - Phone:808-891-1411
Practice Address - Fax:808-891-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty