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General NPI Number Information
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NPI Number | 1801592472
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Entity Type | Organization
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Legal Business Name | YOUTH STYLE FITNESS INC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 911 E MOREHEAD ST
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City | CHARLOTTE
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State | NC
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Zip | 28204-2856
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Country | US
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Telephone | 704-277-8170
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Fax |
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Provider Business Mailing Address
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Address Line | 3020I PROSPERITY CHURCH RD STE 521
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City | CHARLOTTE
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State | NC
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Zip | 28269-8112
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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 | PRESIDENT
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Name | MR. KIM OLIGE II
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Credential |
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Telephone | 704-277-8170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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Taxonomy #7
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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