Provider Demographics
NPI:1316349368
Name:GLAD HEALTH & FITNESS
Entity type:Organization
Organization Name:GLAD HEALTH & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-245-7911
Mailing Address - Street 1:8417 NW 26TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-2917
Mailing Address - Country:US
Mailing Address - Phone:954-245-7911
Mailing Address - Fax:
Practice Address - Street 1:4541 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5376
Practice Address - Country:US
Practice Address - Phone:954-245-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHS108252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty