MEDICARE: TAG HOLISTC FITNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1922862077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAG HOLISTC FITNESS LLC

Provider Business Mailing Address
First Line	:	7340 LUMBER PORT DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-0132
Country	:	US
Telephone Number	:	614-749-9701
Fax Number	:

Provider Business Practice Location Address
First Line	:	7340 LUMBER PORT DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-0132
Country	:	US
Telephone Number	:	614-749-9701
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TAG HOLISTIC FITNESS LLC
Credential	:
Telephone Number	:	614-749-9701

Provider Enumeration Date	:	02/09/2024
Last Update Date	:	02/09/2024

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Directions to “TAG HOLISTC FITNESS LLC ” Practice Location

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