Provider Demographics
NPI:1942980156
Name:HALE LEGACY HEALTH COACHING AND FITNESS LLC.
Entity Type:Organization
Organization Name:HALE LEGACY HEALTH COACHING AND FITNESS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:I KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-065-4051
Mailing Address - Street 1:9737 DOMINION CREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7024
Mailing Address - Country:US
Mailing Address - Phone:704-654-5154
Mailing Address - Fax:
Practice Address - Street 1:9737 DOMINION CREST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7024
Practice Address - Country:US
Practice Address - Phone:704-654-5154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty