Provider Demographics
NPI:1124413356
Name:NUTRITION THERAPY OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:NUTRITION THERAPY OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KOGER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:305-495-6883
Mailing Address - Street 1:13813 SW 90TH AVE
Mailing Address - Street 2:APT. H204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8995
Mailing Address - Country:US
Mailing Address - Phone:305-495-6883
Mailing Address - Fax:
Practice Address - Street 1:13813 SW 90TH AVE
Practice Address - Street 2:APT. H204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8995
Practice Address - Country:US
Practice Address - Phone:305-495-6883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6812133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty