Provider Demographics
NPI:1356686943
Name:SHIP SHAPE WATER FITNESS SPECIALISTS, LLC
Entity type:Organization
Organization Name:SHIP SHAPE WATER FITNESS SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FITNESS TRAINER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:AFAA TRAINER
Authorized Official - Phone:386-986-5655
Mailing Address - Street 1:47 KALAMAZOO TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5633
Mailing Address - Country:US
Mailing Address - Phone:386-986-5655
Mailing Address - Fax:386-313-1886
Practice Address - Street 1:47 KALAMAZOO TRL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5633
Practice Address - Country:US
Practice Address - Phone:386-986-5655
Practice Address - Fax:386-313-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAEA 60145251K00000X
FLAFAA 32385251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare