Provider Demographics
NPI:1336923697
Name:BEACH COWBOY FITNESS FOUNDATION
Entity Type:Organization
Organization Name:BEACH COWBOY FITNESS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:WEIN
Authorized Official - Last Name:LETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-438-4833
Mailing Address - Street 1:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-1625
Mailing Address - Country:US
Mailing Address - Phone:843-438-4833
Mailing Address - Fax:
Practice Address - Street 1:1200 QUEENSBOROUGH BLVD STE B
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3191
Practice Address - Country:US
Practice Address - Phone:843-438-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty