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General NPI Number Information
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NPI Number | 1164283149
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Entity Type | Organization
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Legal Business Name | MUSCLE HOUSE AND FITNESS
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 4340 INDIAN HEAD HWY
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City | INDIAN HEAD
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State | MD
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Zip | 20640-1843
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Country | US
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Telephone | 301-684-2086
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Fax |
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Provider Business Mailing Address
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Address Line | 88 CASWELL DR
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City | INDIAN HEAD
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State | MD
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Zip | 20640-1405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARLENE ANNONI
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Credential |
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Telephone | 301-752-1012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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