Provider Demographics
NPI:1043970031
Name:FOUR FRIENDS FITNESS LLC
Entity Type:Organization
Organization Name:FOUR FRIENDS FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAKENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-235-9429
Mailing Address - Street 1:8106 OLD KINGS RD S STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-5526
Mailing Address - Country:US
Mailing Address - Phone:904-586-2118
Mailing Address - Fax:
Practice Address - Street 1:8106 OLD KINGS RD S STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-5526
Practice Address - Country:US
Practice Address - Phone:904-586-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty