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General NPI Number Information
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NPI Number | 1013806173
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Entity Type | Organization
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Legal Business Name | COACH TEE'S BOXING ACADEMY
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 20001 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44117-1480
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Country | US
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Telephone | 216-465-9942
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Fax |
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Provider Business Mailing Address
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Address Line | 932 LONDON RD
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City | CLEVELAND
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State | OH
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Zip | 44110-3116
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Country | US
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Telephone | 216-394-4648
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | JAPARA GERMANY
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Credential | CDCA,CPRS
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Telephone | 216-400-3315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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