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General NPI Number Information
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NPI Number | 1669123501
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Entity Type | Organization
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Legal Business Name | CREATIVE SWIM THERAPY
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 307 SW GRIMALDO TER
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4360
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Country | US
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Telephone | 772-204-3977
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Fax |
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Provider Business Mailing Address
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Address Line | 307 SW GRIMALDO TER
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4360
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Country | US
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Telephone | 772-204-3977
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SYDNEY BELLE
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Credential |
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Telephone | 772-204-3977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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