Healthcare Provider Details

I. General information

NPI: 1578909180
Provider Name (Legal Business Name): URBAN CYCLING 365, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 FAIRMOUNT AVE
JAMESTOWN NY
14701-2623
US

IV. Provider business mailing address

96 AVALON BLVD
JAMESTOWN NY
14701-4304
US

V. Phone/Fax

Practice location:
  • Phone: 716-665-9516
  • Fax: 716-338-9883
Mailing address:
  • Phone: 716-665-9516
  • Fax: 716-338-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIE LYNN SMITH
Title or Position: OWNER
Credential: N/A
Phone: 716-665-9516