Healthcare Provider Details

I. General information

NPI: 1922242197
Provider Name (Legal Business Name): DANCEFIT.LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 DAUPHIN ST
MOBILE AL
36604-1307
US

IV. Provider business mailing address

PO BOX 6223
MOBILE AL
36660-0223
US

V. Phone/Fax

Practice location:
  • Phone: 251-281-2110
  • Fax: 251-330-1727
Mailing address:
  • Phone: 251-281-2110
  • Fax: 251-330-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANITRA KENNEDY JARREAU
Title or Position: CO-OWNER/INSTRUCTOR
Credential: LPN
Phone: 251-281-2110