Provider Demographics
NPI:1275564494
Name:ADVANCED FITNESS & THERAPY AT ABACOA, INC.
Entity Type:Organization
Organization Name:ADVANCED FITNESS & THERAPY AT ABACOA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:561-694-1243
Mailing Address - Street 1:1200 UNIVERSITY BLVD
Mailing Address - Street 2:#101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5215
Mailing Address - Country:US
Mailing Address - Phone:561-694-1243
Mailing Address - Fax:561-694-8992
Practice Address - Street 1:1200 UNIVERSITY BLVD
Practice Address - Street 2:#101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5215
Practice Address - Country:US
Practice Address - Phone:561-694-1243
Practice Address - Fax:561-694-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106985Medicare Oscar/Certification