Provider Demographics
NPI:1063501484
Name:SUNCOAST FITNESS, INC
Entity Type:Organization
Organization Name:SUNCOAST FITNESS, INC
Other - Org Name:FIT FOR LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLASSCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-367-0075
Mailing Address - Street 1:575 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-1833
Mailing Address - Country:US
Mailing Address - Phone:727-367-0075
Mailing Address - Fax:727-367-0402
Practice Address - Street 1:575 75TH AVE
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-1833
Practice Address - Country:US
Practice Address - Phone:727-367-0075
Practice Address - Fax:727-367-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEXEMPTION# HCC1162261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4546Medicare ID - Type UnspecifiedMEDICARE PROVIDER #