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General NPI Number Information
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NPI Number | 1255620894
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Entity Type | Organization
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Legal Business Name | STOPS FASTTRACK, LLC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 8855 GRISSOM PKWY
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City | TITUSVILLE
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State | FL
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Zip | 32780-7904
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Country | US
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Telephone | 866-285-5652
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Fax | 321-383-5430
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Provider Business Mailing Address
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Address Line | 8855 GRISSOM PKWY
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City | TITUSVILLE
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State | FL
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Zip | 32780-7904
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Country | US
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Telephone | 866-285-5652
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Fax | 321-383-5430
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT A COOK
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Credential |
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Telephone | 321-383-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 11-00005304
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License Number State | FL
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