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General NPI Number Information
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NPI Number | 1366032401
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Entity Type | Organization
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Legal Business Name | MARTIAL ARTS COMBAT ACADEMY
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 1605 PARTIN DR N
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City | NICEVILLE
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State | FL
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Zip | 32578-1447
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Country | US
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Telephone | 850-499-8874
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Fax |
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Provider Business Mailing Address
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Address Line | 4237 MARYSA DR
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City | NICEVILLE
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State | FL
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Zip | 32578-1753
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Country | US
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Telephone | 850-499-8874
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JAY HAROLD FOIL
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Credential |
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Telephone | 850-499-8874
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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 |
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