Provider Demographics
NPI:1265754246
Name:FITNESS FOR LIFE PERSONAL TRAINING STUDIO
Entity type:Organization
Organization Name:FITNESS FOR LIFE PERSONAL TRAINING STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS COORDINATOR/VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-876-8172
Mailing Address - Street 1:1232 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2745
Mailing Address - Country:US
Mailing Address - Phone:985-876-8172
Mailing Address - Fax:985-876-8173
Practice Address - Street 1:1232 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2745
Practice Address - Country:US
Practice Address - Phone:985-876-8172
Practice Address - Fax:985-876-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN088069163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty