MEDICARE: DESFIT & DANCE LLC

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	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962075267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESFIT & DANCE LLC

Provider Business Mailing Address
First Line	:	2604 BERKLEY ST
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-2830
Country	:	US
Telephone Number	:	202-425-4108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 WADE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5906
Country	:	US
Telephone Number	:	202-425-4108
Fax Number	:

Authorized Official
Title or Position	:	CEO/ OWNER
Name	:	MS. DESTINIE BROWNLEE
Credential	:
Telephone Number	:	202-908-8149

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/23/2021

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Directions to “DESFIT & DANCE LLC ” Practice Location

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