Provider Demographics
NPI:1245533595
Name:RELATIONSHIP FITNESS CENTER
Entity type:Organization
Organization Name:RELATIONSHIP FITNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER- DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUPITER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, CWP
Authorized Official - Phone:281-905-5586
Mailing Address - Street 1:531 CRESTWATER CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1517
Mailing Address - Country:US
Mailing Address - Phone:832-243-4901
Mailing Address - Fax:832-243-4901
Practice Address - Street 1:2630 FOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 375
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7608
Practice Address - Country:US
Practice Address - Phone:713-278-1940
Practice Address - Fax:832-243-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1959213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty