Intersport Fitness Center

Primary specialty

Health EducatorTaxonomy code 174H00000X

License

164631 Issued in CA

Legal business name

INTERSPORT FITNESS CENTER

Practice address

4847 Stratos Way
Modesto, CA 95356-9544

Phone

(209) 522-9309

NPI assigned

Oct 10, 2011

Last updated

Oct 13, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Loretta Garcia Laughlin, CPT

Title

Owner

Phone

(209) 480-9309

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1508140500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4847 STRATOS WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569544",
            "telephone_number": "209-522-9309",
            "fax_number": "209-522-9365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4847 STRATOS WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569544",
            "telephone_number": "209-522-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERSPORT FITNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-10",
        "last_updated": "2011-10-13",
        "status": "A",
        "authorized_official_last_name": "LAUGHLIN",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_middle_name": "GARCIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-480-9309",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPT"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Health Educator",
            "state": "CA",
            "license": "164631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Educator in Modesto, CA
• Providers in Modesto, CA by specialty
• Health Educator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.