Organization
FRESH FITNESS & STRETCH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN S NICOLAS (CEO)
(786) 559-1268
Entity
Organization
Contact information
Practice address
230 NE 175TH TER, NORTH MIAMI BEACH, FL 33162-1764
(305) 731-0103
Mailing address
18117 BISCAYNE BLVD # 1061, AVENTURA, FL 33160-2535
(786) 559-1268
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
06/09/2019
Last updated
12/29/2020
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