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General NPI Number Information
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NPI Number | 1861217309
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Entity Type | Organization
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Legal Business Name | B.E. ACTIVE FITNESS AND CONSULTING, LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 177 SOUTHILL DR
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City | LEESBURG
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State | GA
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Zip | 31763-4535
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Country | US
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Telephone | 229-456-1509
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Fax |
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Provider Business Mailing Address
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Address Line | 177 SOUTHILL DR
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City | LEESBURG
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State | GA
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Zip | 31763-4535
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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 | OWNER
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Name | BRITTANY ENGLISH
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Credential | DPT
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Telephone | 229-456-1509
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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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