Healthcare Provider Details

I. General information

NPI: 1770316655
Provider Name (Legal Business Name): FITNESS-4-DOWNS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 E SLIGH AVE
TAMPA FL
33617-9102
US

IV. Provider business mailing address

6209 N 22ND ST
TAMPA FL
33610-1345
US

V. Phone/Fax

Practice location:
  • Phone: 813-744-5978
  • Fax:
Mailing address:
  • Phone: 813-869-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE NATHANIEL BAKER JR.
Title or Position: HEAD FITNESS INSTRUCTOR /COACH
Credential: IAFS CPT
Phone: 813-869-4360