Healthcare Provider Details

I. General information

NPI: 1104175439
Provider Name (Legal Business Name): ADAPTIVE FITNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 CORAL WAY STE 103
CORAL GABLES FL
33145
US

IV. Provider business mailing address

2520 CORAL WAY STE 2-506
MIAMI FL
33145-3438
US

V. Phone/Fax

Practice location:
  • Phone: 305-960-7292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE FLORES
Title or Position: ACCOUNT SPECIALIST
Credential:
Phone: 754-201-2265