Provider Demographics
NPI:1518590801
Name:OUR TEAM FITNESS LLC
Entity type:Organization
Organization Name:OUR TEAM FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIK
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, RD, LDN
Authorized Official - Phone:215-514-6988
Mailing Address - Street 1:117 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1238
Mailing Address - Country:US
Mailing Address - Phone:848-208-5027
Mailing Address - Fax:
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1238
Practice Address - Country:US
Practice Address - Phone:848-208-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service