Provider Demographics
NPI:1508490624
Name:ENERGIZED FITNESS, LLC
Entity Type:Organization
Organization Name:ENERGIZED FITNESS, LLC
Other - Org Name:ENERGIZED HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRONGELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-767-2737
Mailing Address - Street 1:113 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-9135
Mailing Address - Country:US
Mailing Address - Phone:570-617-9005
Mailing Address - Fax:
Practice Address - Street 1:16421 N TATUM BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3457
Practice Address - Country:US
Practice Address - Phone:602-767-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty