Healthcare Provider Details

I. General information

NPI: 1235874744
Provider Name (Legal Business Name): NOCO FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 W 10TH ST STE B10
GREELEY CO
80634-1599
US

IV. Provider business mailing address

3820 W 10TH ST STE B10
GREELEY CO
80634-1599
US

V. Phone/Fax

Practice location:
  • Phone: 970-978-4392
  • Fax:
Mailing address:
  • Phone: 970-978-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ERIKA HARTMANN
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 970-402-6042