Provider Demographics
NPI:1326630344
Name:THE GYM FITNESS CENTER, LLC
Entity Type:Organization
Organization Name:THE GYM FITNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:CANDELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-577-3129
Mailing Address - Street 1:13121 GRANT CIR
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8100
Mailing Address - Country:US
Mailing Address - Phone:810-577-3129
Mailing Address - Fax:
Practice Address - Street 1:4290 MILLER RD STE 4
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1283
Practice Address - Country:US
Practice Address - Phone:810-285-9765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty