Provider Demographics
NPI:1528443017
Name:STEEM FITNESS & MASSAGE LLC
Entity type:Organization
Organization Name:STEEM FITNESS & MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPASS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:954-471-7950
Mailing Address - Street 1:16951 SW 63RD MNR
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1773
Mailing Address - Country:US
Mailing Address - Phone:954-471-7950
Mailing Address - Fax:
Practice Address - Street 1:4621 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4602
Practice Address - Country:US
Practice Address - Phone:954-471-7950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 78630OtherNPI #1104209410