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General NPI Number Information
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NPI Number | 1477090736
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Entity Type | Organization
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Legal Business Name | YOGA BY PRESCRIPTION
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 1340 SE 4TH CT
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4994
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Country | US
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Telephone | 954-612-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 SE 4TH CT
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4994
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Country | US
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Telephone | 954-612-1100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, PROVIDER
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Name | LESLY KUJAWA
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Credential | RYT200
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Telephone | 954-612-1100
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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 | #171772
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License Number State | FL
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