Healthcare Provider Details

I. General information

NPI: 1689988248
Provider Name (Legal Business Name): FLYING HIGH GYMNASTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EAST AVE
COUNTRYSIDE IL
60525-3112
US

IV. Provider business mailing address

5400 EAST AVE
COUNTRYSIDE IL
60525-3112
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-3099
  • Fax: 708-698-1000
Mailing address:
  • Phone: 708-352-3099
  • Fax: 708-698-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA MEYER
Title or Position: OWNER
Credential:
Phone: 708-352-3099