Provider Demographics
NPI:1194450056
Name:FIZKIDZ FITNESS LLC
Entity type:Organization
Organization Name:FIZKIDZ FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:RASHAD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-445-6503
Mailing Address - Street 1:1222 BRENTON LEAF DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-7991
Mailing Address - Country:US
Mailing Address - Phone:469-445-6503
Mailing Address - Fax:
Practice Address - Street 1:1222 BRENTON LEAF DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-7991
Practice Address - Country:US
Practice Address - Phone:469-445-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare