=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245533595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELATIONSHIP FITNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2010
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2630 FOUNTAIN VIEW DR SUITE 375
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-7608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-278-1940
-----------------------------------------------------
Fax | 832-243-4901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 531 CRESTWATER CT
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77082-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-243-4901
-----------------------------------------------------
Fax | 832-243-4901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER- DIRECTOR
-----------------------------------------------------
Name | DR. STEPHANIE JUPITER
-----------------------------------------------------
Credential | DPM, CWP
-----------------------------------------------------
Telephone | 281-905-5586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | 1959
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------