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General NPI Number Information
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NPI Number | 1487308979
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Entity Type | Organization
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Legal Business Name | TEAM BODY FITNESS LLC
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 5181 MARINER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34609-1834
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Country | US
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Telephone | 352-686-4660
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Fax |
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Provider Business Mailing Address
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Address Line | 11457 EXMORE ST
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City | SPRING HILL
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State | FL
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Zip | 34609-2130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPT
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Name | RONALD SAMANIEGO
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Credential |
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Telephone | 224-368-7133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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