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General NPI Number Information
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NPI Number | 1023560844
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Entity Type | Organization
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Legal Business Name | CENTER FOR NEUROFITNESS LLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 248 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 904-797-5680
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Fax | 904-797-5681
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Provider Business Mailing Address
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Address Line | 248 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 904-797-5680
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Fax | 904-797-5681
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS H SWISSHELM
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Credential | MED, EDS, BCN
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Telephone | 904-797-5680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472E0500X
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Taxonomy Name | EEG Technician
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License Number |
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License Number State |
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