Provider Demographics
NPI:1225866445
Name:4D COACHING LLC
Entity type:Organization
Organization Name:4D COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-377-9606
Mailing Address - Street 1:19924 JETTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8253
Mailing Address - Country:US
Mailing Address - Phone:704-997-8012
Mailing Address - Fax:704-270-8219
Practice Address - Street 1:19924 JETTON RD STE 104
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8253
Practice Address - Country:US
Practice Address - Phone:704-997-8012
Practice Address - Fax:704-270-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty