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General NPI Number Information
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NPI Number | 1467190082
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Entity Type | Organization
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Legal Business Name | SPECIAL FITNESS LLC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 314 CLIFF AVE UPPR
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City | RACINE
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State | WI
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Zip | 53404-3202
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Country | US
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Telephone | 262-900-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 314 CLIFF AVE UPPR
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City | RACINE
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State | WI
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Zip | 53404-3202
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Country | US
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Telephone | 262-900-7247
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Fax |
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Authorized Official
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Title or Position | CEO, PERSONAL TRAINER
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Name | MR. MICHAEL MOLINARO III
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Credential | PERSONAL TRAINER
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Telephone | 262-900-7247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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