Healthcare Provider Details

I. General information

NPI: 1942980156
Provider Name (Legal Business Name): HALE LEGACY HEALTH COACHING AND FITNESS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9737 DOMINION CREST DR
CHARLOTTE NC
28269-7024
US

IV. Provider business mailing address

9737 DOMINION CREST DR
CHARLOTTE NC
28269-7024
US

V. Phone/Fax

Practice location:
  • Phone: 704-654-5154
  • Fax:
Mailing address:
  • Phone: 704-654-5154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name: MAIYA I KEELING
Title or Position: OWNER
Credential:
Phone: 704-065-4051