Provider Demographics
NPI:1922862077
Name:TAG HOLISTC FITNESS LLC
Entity Type:Organization
Organization Name:TAG HOLISTC FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAG
Authorized Official - Middle Name:HOLISTIC FITNESS
Authorized Official - Last Name:LLC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-749-9701
Mailing Address - Street 1:7340 LUMBER PORT DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-0132
Mailing Address - Country:US
Mailing Address - Phone:614-749-9701
Mailing Address - Fax:
Practice Address - Street 1:7340 LUMBER PORT DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-0132
Practice Address - Country:US
Practice Address - Phone:614-749-9701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty