Provider Demographics
NPI:1255796843
Name:REP FITNESS
Entity type:Organization
Organization Name:REP FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN DAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-240-9231
Mailing Address - Street 1:632 ERIN PARK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2705
Mailing Address - Country:US
Mailing Address - Phone:360-240-9231
Mailing Address - Fax:
Practice Address - Street 1:632 ERIN PARK RD
Practice Address - Street 2:SUITE A
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2705
Practice Address - Country:US
Practice Address - Phone:360-240-9231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty