Provider Demographics
NPI:1790137677
Name:JANT ENTERPRISES,INC,
Entity Type:Organization
Organization Name:JANT ENTERPRISES,INC,
Other - Org Name:CREATED PLAYERS PERSONAL TRAINING AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANT
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,CFT,CSCS
Authorized Official - Phone:434-210-2181
Mailing Address - Street 1:1604 W LITTLE CREEK RD
Mailing Address - Street 2:APT 104
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-1885
Mailing Address - Country:US
Mailing Address - Phone:434-210-2181
Mailing Address - Fax:
Practice Address - Street 1:1604 W LITTLE CREEK RD
Practice Address - Street 2:APT 104
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-1885
Practice Address - Country:US
Practice Address - Phone:434-210-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty