Healthcare Provider Details

I. General information

NPI: 1255796843
Provider Name (Legal Business Name): REP FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 ERIN PARK RD SUITE A
OAK HARBOR WA
98277-2705
US

IV. Provider business mailing address

632 ERIN PARK RD SUITE A
OAK HARBOR WA
98277-2705
US

V. Phone/Fax

Practice location:
  • Phone: 360-240-9231
  • Fax:
Mailing address:
  • Phone: 360-240-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. TYSON J VAN DAM
Title or Position: OWNER
Credential:
Phone: 360-240-9231