Demi's Fitness and Learning Academy NFP

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

KB21490817P Issued in IL

Legal business name

DEMI'S FITNESS AND LEARNING ACADEMY NFP

Practice address

4901 S Drexel Blvd Apt 226
Chicago, IL 60615-2763

Phone

(872) 333-1050

NPI assigned

Aug 31, 2017

Organization subpart

No

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

Authorized official

Name

Koko Burruss, DT

Title

Developmental Therapist

Phone

(872) 333-1050

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1568980456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 S DREXEL BLVD APT 226",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606152763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 S DREXEL BLVD APT 226",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606152763",
            "telephone_number": "872-333-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEMI'S FITNESS AND LEARNING ACADEMY NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-31",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "BURRUSS",
        "authorized_official_first_name": "KOKO",
        "authorized_official_title_or_position": "DEVELOPMENTAL THERAPIST",
        "authorized_official_telephone_number": "872-333-1050",
        "authorized_official_credential": "DT"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": "KB21490817P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053831420",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Demes, CCC-SLP
• Angelo Demetrakakis, D.D.S.
• Melchor V Demetria, M.D.
• Demetrios Petrovas M.D. S.C.
• Demi Maropoulos Nutrition Counseling, LLC
• Adina Simona Demian, D.M.D.
• Barbara Demianiuk
• Yulia M Demidovich, MD
• Demimonde Therapy PLLC
• Kevin Deming, BCBA

• Developmental Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.