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General NPI Number Information
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NPI Number | 1265976963
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Entity Type | Organization
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Legal Business Name | 1ST STEP FITNESS
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 95 RIVERPORT DR
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City | JACKSON
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State | TN
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Zip | 38301-5748
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Country | US
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Telephone | 731-298-4506
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Fax |
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Provider Business Mailing Address
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Address Line | 95 RIVERPORT DR
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City | JACKSON
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State | TN
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Zip | 38301-5748
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Country | US
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Telephone | 731-298-4506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN LEE PARKER
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Credential |
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Telephone | 731-298-4506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | TN
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