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General NPI Number Information
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NPI Number | 1316349368
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Entity Type | Organization
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Legal Business Name | GLAD HEALTH & FITNESS
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 4541 N PINE ISLAND RD
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City | SUNRISE
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State | FL
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Zip | 33351-5376
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Country | US
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Telephone | 954-245-7911
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Fax |
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Provider Business Mailing Address
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Address Line | 8417 NW 26TH PL
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City | SUNRISE
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State | FL
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Zip | 33322-2917
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Country | US
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Telephone | 954-245-7911
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GLADIMIR SIMEON
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Credential |
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Telephone | 954-245-7911
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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 | HS10825
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License Number State | FL
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