Healthcare Provider Details

I. General information

NPI: 1144134628
Provider Name (Legal Business Name): DANCESPORT STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EVES DR STE A114
MARLTON NJ
08053-3103
US

IV. Provider business mailing address

4 EVES DR STE A114
MARLTON NJ
08053-3103
US

V. Phone/Fax

Practice location:
  • Phone: 800-817-3550
  • Fax:
Mailing address:
  • Phone: 800-817-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE BLANK
Title or Position: OWNER
Credential:
Phone: 800-817-3550