Provider Demographics
NPI:1316721855
Name:MIXED ATHLETIC PERFORMANCE TRAINING
Entity type:Organization
Organization Name:MIXED ATHLETIC PERFORMANCE TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEWERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:916-642-9942
Mailing Address - Street 1:8665 AUBURN FOLSOM RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-8510
Mailing Address - Country:US
Mailing Address - Phone:916-642-9942
Mailing Address - Fax:
Practice Address - Street 1:8665 AUBURN FOLSOM RD
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-8510
Practice Address - Country:US
Practice Address - Phone:916-642-9942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service