| Organization Name: | ACTIVE LIFESTYLES WELLNESS & PERFORMANCE CTR |
| NPI Number: | 1154378875 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GIORGIO G RES (OWNER) |
| Mailing Address: | 1715 37th Pl Third Floor Vero Beach |
| State: | FL US |
| Postal Code: | 329604502 |
| Phone Number: | 7729787379 |
| Fax Number: | 7725398515 |
| NPI Enumeration Date: | 05/28/2006 |
| NPI Last Update Date: | 01/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | PT22446 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |