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General NPI Number Information
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NPI Number | 1316320971
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Entity Type | Organization
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Legal Business Name | K-SQUARED FITNESS, L.L.C.
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 1100 CLIFF RD
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City | EAGAN
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State | MN
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Zip | 55123
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Country | US
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Telephone | 612-548-4660
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Fax |
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Provider Business Mailing Address
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Address Line | 4560 CINNAMON RIDGE TRL
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City | EAGAN
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State | MN
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Zip | 55122-3307
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Country | US
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Telephone | 612-548-4660
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Fax |
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Authorized Official
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Title or Position | PERSONAL TRAINER AND COO
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Name | MS. KARA B ROSE
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Credential |
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Telephone | 612-548-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 1412900570
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License Number State | GA
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