Provider Demographics
NPI:1225388499
Name:LEAP FITNESS ACADEMY
Entity Type:Organization
Organization Name:LEAP FITNESS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-716-7553
Mailing Address - Street 1:4274 KNOLLCROFT RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1932
Mailing Address - Country:US
Mailing Address - Phone:937-716-7553
Mailing Address - Fax:
Practice Address - Street 1:4274 KNOLLCROFT RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1932
Practice Address - Country:US
Practice Address - Phone:937-716-7553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization