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General NPI Number Information
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NPI Number | 1356686943
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Entity Type | Organization
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Legal Business Name | SHIP SHAPE WATER FITNESS SPECIALISTS, LLC
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 47 KALAMAZOO TRL
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City | PALM COAST
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State | FL
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Zip | 32164-5633
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Country | US
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Telephone | 386-986-5655
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Fax | 386-313-1886
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Provider Business Mailing Address
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Address Line | 47 KALAMAZOO TRL
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City | PALM COAST
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State | FL
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Zip | 32164-5633
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Country | US
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Telephone | 386-986-5655
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Fax | 386-313-1886
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Authorized Official
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Title or Position | FITNESS TRAINER
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Name | MS. SHARON M. SMITH
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Credential | AFAA TRAINER
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Telephone | 386-986-5655
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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 | AEA 60145
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | AFAA 32385
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License Number State | FL
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