Healthcare Provider Details

I. General information

NPI: 1023528049
Provider Name (Legal Business Name): FIT ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 147TH ST W
APPLE VALLEY MN
55124-9008
US

IV. Provider business mailing address

7200 147TH ST W
APPLE VALLEY MN
55124-9008
US

V. Phone/Fax

Practice location:
  • Phone: 952-847-3798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier41-4006097
Identifier TypeOTHER
Identifier State
Identifier IssuerNON PROFIT EDUCATIONAL

VIII. Authorized Official

Name: CLAUD ALLAIRE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 952-847-3798