Provider Demographics
NPI:1760071187
Name:CAPTAIN PERKS PERSONAL TRAINING
Entity Type:Organization
Organization Name:CAPTAIN PERKS PERSONAL TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JANCY
Authorized Official - Middle Name:JERROLD
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-233-4129
Mailing Address - Street 1:2001 E JUDGE PEREZ DR STE C
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-5854
Mailing Address - Country:US
Mailing Address - Phone:504-233-4129
Mailing Address - Fax:
Practice Address - Street 1:2001 E JUDGE PEREZ DR STE C
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-5854
Practice Address - Country:US
Practice Address - Phone:504-233-4129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy