Provider Demographics
NPI:1730636358
Name:TKJ, LLC
Entity Type:Organization
Organization Name:TKJ, LLC
Other - Org Name:ANYTIME FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:REILEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-360-0038
Mailing Address - Street 1:655 PALISADE TRL
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5069
Mailing Address - Country:US
Mailing Address - Phone:208-360-0038
Mailing Address - Fax:
Practice Address - Street 1:1251 ARROWHEAD PLAZA WAY
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422
Practice Address - Country:US
Practice Address - Phone:208-354-9675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty