Provider Demographics
NPI:1962075267
Name:DESFIT & DANCE LLC
Entity type:Organization
Organization Name:DESFIT & DANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DESTINIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-908-8149
Mailing Address - Street 1:2604 BERKLEY ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-2830
Mailing Address - Country:US
Mailing Address - Phone:202-425-4108
Mailing Address - Fax:
Practice Address - Street 1:2636 WADE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5906
Practice Address - Country:US
Practice Address - Phone:202-425-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD011587613Medicaid