Provider Demographics
NPI:1467190082
Name:SPECIAL FITNESS LLC
Entity Type:Organization
Organization Name:SPECIAL FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PERSONAL TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINARO
Authorized Official - Suffix:III
Authorized Official - Credentials:PERSONAL TRAINER
Authorized Official - Phone:262-900-7247
Mailing Address - Street 1:314 CLIFF AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-3202
Mailing Address - Country:US
Mailing Address - Phone:262-900-7247
Mailing Address - Fax:
Practice Address - Street 1:314 CLIFF AVE UPPR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-3202
Practice Address - Country:US
Practice Address - Phone:262-900-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty