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Organization
DEMI'S FITNESS AND LEARNING ACADEMY NFP
Active
Organization
DEMI'S FITNESS AND LEARNING ACADEMY NFP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOKO BURRUSS DT (DEVELOPMENTAL THERAPIST)
(872) 333-1050
Entity
Organization
Contact information
Practice address
4901 S DREXEL BLVD APT 226, CHICAGO, IL 60615-2763
(872) 333-1050
Mailing address
4901 S DREXEL BLVD APT 226, CHICAGO, IL 60615-2763
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
KB21490817P
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053831420
—
IL
Enumeration date
08/31/2017
Last updated
06/16/2018
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