Provider Demographics
NPI:1235456187
Name:FAMILY FITNESS
Entity Type:Organization
Organization Name:FAMILY FITNESS
Other - Org Name:TROPHY KINGS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEY
Authorized Official - Suffix:I
Authorized Official - Credentials:CERTIFIED PT/NUTRIT
Authorized Official - Phone:702-533-1301
Mailing Address - Street 1:7348 RIDGE STAR CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8204
Mailing Address - Country:US
Mailing Address - Phone:702-533-1301
Mailing Address - Fax:
Practice Address - Street 1:7348 RIDGE STAR CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8204
Practice Address - Country:US
Practice Address - Phone:702-533-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV2010277428133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty