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General NPI Number Information
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NPI Number | 1346809290
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Entity Type | Organization
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Legal Business Name | INITIUM NOVUM LLC
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 1657 N MIAMI AVE APT 515
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City | MIAMI
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State | FL
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Zip | 33136-2010
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Country | US
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Telephone | 310-367-7517
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Fax |
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Provider Business Mailing Address
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Address Line | 1657 N MIAMI AVE APT 515
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City | MIAMI
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State | FL
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Zip | 33136-2010
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Country | US
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Telephone | 310-367-7517
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HUMAN PERFORMANCE
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Name | TERRENCE VALENTINO BAILEY
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Credential | EXERCISEPHYSIOLOGIST
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Telephone | 310-367-7517
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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