Provider Demographics
NPI:1376169490
Name:ZAK NORDYKE HOLISTIC FITNESS
Entity Type:Organization
Organization Name:ZAK NORDYKE HOLISTIC FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NORDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-623-8422
Mailing Address - Street 1:5880 WINTON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45232-1121
Mailing Address - Country:US
Mailing Address - Phone:513-276-9238
Mailing Address - Fax:
Practice Address - Street 1:5880 WINTON RIDGE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45232-1121
Practice Address - Country:US
Practice Address - Phone:513-276-9238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty