Provider Demographics
NPI: | 1639532617 |
---|---|
Name: | NEWMAN'S BODYSHOP PERSONAL TRAINING INC. |
Entity Type: | Organization |
Organization Name: | NEWMAN'S BODYSHOP PERSONAL TRAINING INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EARL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NEWMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 202-903-7616 |
Mailing Address - Street 1: | 6431 OLD BRANCH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | TEMPLE HILLS |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20748-2607 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6431 OLD BRANCH AVE |
Practice Address - Street 2: | |
Practice Address - City: | TEMPLE HILLS |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20748-2607 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-903-7616 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-03-29 |
Last Update Date: | 2016-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | Group - Single Specialty |