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General NPI Number Information
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NPI Number | 1538820501
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Entity Type | Organization
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Legal Business Name | CLUB SPIN
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 9318 E COLONIAL DR STE A11
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City | ORLANDO
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State | FL
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Zip | 32817-4175
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Country | US
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Telephone | 407-259-9105
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Fax |
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Provider Business Mailing Address
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Address Line | 7810 JUBILEE PARK BLVD APT 125
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City | ORLANDO
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State | FL
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Zip | 32822-5196
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Country | US
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Telephone | 407-259-9105
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHRISTOPHER AINA
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Credential |
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Telephone | 407-259-9105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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