Provider Demographics
NPI:1114384401
Name:SCULPTURE NUTRITION & FITNESS
Entity Type:Organization
Organization Name:SCULPTURE NUTRITION & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CULP
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSSD, LD
Authorized Official - Phone:512-517-7624
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:BUILDING 8, SUITE 800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-994-4594
Mailing Address - Fax:512-306-1403
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BUILDING 8, SUITE 800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-994-4594
Practice Address - Fax:512-306-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06505133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty