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General NPI Number Information
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NPI Number | 1669818019
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Entity Type | Organization
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Legal Business Name | THE FITNESS ARTIST LLC
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 1581 ROUTE 9
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City | CLIFTON PARK
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State | NY
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Zip | 12065-5606
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Country | US
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Telephone | 518-982-1775
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Fax |
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Provider Business Mailing Address
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Address Line | 1581 ROUTE 9
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City | CLIFTON PARK
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State | NY
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Zip | 12065-5606
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Country | US
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Telephone | 518-982-1775
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TRAVIS JOHN GIL
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Credential |
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Telephone | 518-275-8348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 195967871
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License Number State | NY
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