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General NPI Number Information
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NPI Number | 1114275237
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Entity Type | Organization
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Legal Business Name | ULTIMATE RESULTS AT SOUTH RIDING
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 25055 RIDING PLZ SUITE 130
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City | CHANTILLY
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State | VA
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Zip | 20152-5917
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Country | US
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Telephone | 703-220-6917
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Fax |
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Provider Business Mailing Address
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Address Line | 25055 RIDING PLZ SUITE 130
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City | CHANTILLY
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State | VA
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Zip | 20152-5917
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Country | US
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Telephone | 703-220-6917
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Fax |
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Authorized Official
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Title or Position | OWNER, HEAD TRAINER
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Name | MR. NICHOLAS ALEXANDER FURST
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Credential | CPT
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Telephone | 703-220-6917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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