Provider Demographics
NPI:1316320971
Name:K-SQUARED FITNESS, L.L.C.
Entity type:Organization
Organization Name:K-SQUARED FITNESS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PERSONAL TRAINER AND COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-548-4600
Mailing Address - Street 1:4560 CINNAMON RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3307
Mailing Address - Country:US
Mailing Address - Phone:612-548-4660
Mailing Address - Fax:
Practice Address - Street 1:1100 CLIFF RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123
Practice Address - Country:US
Practice Address - Phone:612-548-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1412900570251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1700268828OtherINDIVIDUAL NPI