Provider Demographics
NPI:1891045316
Name:LIVE 2 B HEALTHY SENIOR FITNESS, LLC
Entity type:Organization
Organization Name:LIVE 2 B HEALTHY SENIOR FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CZEPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-702-2679
Mailing Address - Street 1:6110 BLUE CIRCLE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9128
Mailing Address - Country:US
Mailing Address - Phone:612-702-2679
Mailing Address - Fax:
Practice Address - Street 1:6110 BLUE CIRCLE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9128
Practice Address - Country:US
Practice Address - Phone:612-702-2679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty