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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