MEDICARE: COACH TEE'S BOXING ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1013806173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COACH TEE'S BOXING ACADEMY

Provider Business Mailing Address
First Line	:	932 LONDON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3116
Country	:	US
Telephone Number	:	216-394-4648
Fax Number	:

Provider Business Practice Location Address
First Line	:	20001 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44117-1480
Country	:	US
Telephone Number	:	216-465-9942
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	JAPARA GERMANY
Credential	:	CDCA,CPRS
Telephone Number	:	216-400-3315

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	07/01/2025

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