Provider Demographics
NPI:1427233659
Name:GSWIZZ LADIES WORKOUT EXPRESS
Entity type:Organization
Organization Name:GSWIZZ LADIES WORKOUT EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-272-9792
Mailing Address - Street 1:13419 US HIGHWAY 290 E
Mailing Address - Street 2:BLDG # 7
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4589
Mailing Address - Country:US
Mailing Address - Phone:512-272-9792
Mailing Address - Fax:
Practice Address - Street 1:13419 US HIGHWAY 290 E
Practice Address - Street 2:BLDG # 7
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-4589
Practice Address - Country:US
Practice Address - Phone:512-272-9792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20070218302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization