Provider Demographics
NPI:1114275237
Name:ULTIMATE RESULTS AT SOUTH RIDING
Entity Type:Organization
Organization Name:ULTIMATE RESULTS AT SOUTH RIDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, HEAD TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FURST
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:703-220-6917
Mailing Address - Street 1:25055 RIDING PLZ
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5917
Mailing Address - Country:US
Mailing Address - Phone:703-220-6917
Mailing Address - Fax:
Practice Address - Street 1:25055 RIDING PLZ
Practice Address - Street 2:SUITE 130
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5917
Practice Address - Country:US
Practice Address - Phone:703-220-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty