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General NPI Number Information
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NPI Number | 1902380686
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Entity Type | Organization
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Legal Business Name | SUNSATIONALL KIDZ GYM
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 2154 CENTRAL FLORIDA PKWY STE B2
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City | ORLANDO
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State | FL
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Zip | 32837-8986
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Country | US
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Telephone | 407-203-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 2154 CENTRAL FLORIDA PKWY STE B2
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City | ORLANDO
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State | FL
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Zip | 32837-8986
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Country | US
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Telephone | 407-203-0303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIYUN P FAUBERT
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Credential |
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Telephone | 407-203-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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