Healthcare Provider Details

I. General information

NPI: 1912409871
Provider Name (Legal Business Name): ONWARD PERSONAL TRAINING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 W BIG BEAVER RD STE 228
TROY MI
48084
US

IV. Provider business mailing address

3250 W BIG BEAVER RD STE 300A
TROY MI
48084-2900
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-3633
  • Fax: 248-281-0515
Mailing address:
  • Phone: 248-792-3633
  • Fax: 248-281-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY ROSE DUDA
Title or Position: PRESIDENT/COO
Credential:
Phone: 248-792-3633