| NPI | 1609672864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA COULON Manager 346-413-1887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 133N00000X Nutritionist | |
| 163W00000X Registered Nurse | |
| 171400000X Health & Wellness Coach | |
| 225100000X Physical Therapist | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-02-19 |