Provider Demographics
NPI: | 1487662854 |
---|---|
Name: | THE FITNESS FORMULA, INC. |
Entity type: | Organization |
Organization Name: | THE FITNESS FORMULA, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DONNA |
Authorized Official - Middle Name: | ALEXANDER |
Authorized Official - Last Name: | ISRAEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD, RD, LD, LPC |
Authorized Official - Phone: | 972-238-1811 |
Mailing Address - Street 1: | 1177 ROCKINGHAM |
Mailing Address - Street 2: | STE 128 |
Mailing Address - City: | RICHARDSON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75205 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-238-1811 |
Mailing Address - Fax: | 972-690-3755 |
Practice Address - Street 1: | 1177 ROCKINGHAM LN |
Practice Address - Street 2: | STE 128 |
Practice Address - City: | RICHARDSON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75205-4373 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-238-1811 |
Practice Address - Fax: | 972-690-3755 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-03 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty |