Provider Demographics
NPI:1225549579
Name:EMBODYFITNESS COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:EMBODYFITNESS COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD CSSD LDN
Authorized Official - Phone:781-999-2503
Mailing Address - Street 1:18 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4906
Mailing Address - Country:US
Mailing Address - Phone:781-999-2503
Mailing Address - Fax:
Practice Address - Street 1:18 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4906
Practice Address - Country:US
Practice Address - Phone:781-999-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2768261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center