MEDICARE: SPAIN INTERNATIONAL FITNESS TRAINING

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	133N00000X	Nutritionist	2728294	TX
2	174H00000X	Health Educator	2728293	TX
3	207L00000X	Anesthesiology Physician		TX
4	207LP2900X	Pain Medicine (Anesthesiology) Physician		TX
5	111N00000X	Chiropractor	4425	TX

General Provider Information

NPI Number	:	1215287701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPAIN INTERNATIONAL FITNESS TRAINING

Provider Business Mailing Address
First Line	:	5664 PERRIN ST
Second Line	:
City	:	THE COLONY
State	:	TX
Zip	:	75056-1904
Country	:	US
Telephone Number	:	214-205-8915
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N SAINT PAUL ST
Second Line	:	STE 310
City	:	DALLAS
State	:	TX
Zip	:	75201-3114
Country	:	US
Telephone Number	:	214-205-8915
Fax Number	:

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	DENIELLE SPAIN
Credential	:
Telephone Number	:	214-205-8915

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	06/14/2016

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Directions to “SPAIN INTERNATIONAL FITNESS TRAINING ” Practice Location

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