Provider Demographics
NPI:1093180507
Name:SPAIN INTERNATIONAL FITNESS TRAINING, LLC
Entity type:Organization
Organization Name:SPAIN INTERNATIONAL FITNESS TRAINING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-205-8915
Mailing Address - Street 1:400 N SAINT PAUL ST
Mailing Address - Street 2:STE 305
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3114
Mailing Address - Country:US
Mailing Address - Phone:214-205-8915
Mailing Address - Fax:469-904-2740
Practice Address - Street 1:400 N SAINT PAUL ST
Practice Address - Street 2:STE 310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3114
Practice Address - Country:US
Practice Address - Phone:469-408-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111NS0005X, 133N00000X, 174H00000X, 111N00000X
TXM8869207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty