Provider Demographics
NPI:1275832149
Name:TOP DOG NUTRITION & FITNESS
Entity Type:Organization
Organization Name:TOP DOG NUTRITION & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER/CO-OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-872-1749
Mailing Address - Street 1:4708 GIBSON RD
Mailing Address - Street 2:#105
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-6042
Mailing Address - Country:US
Mailing Address - Phone:228-872-1749
Mailing Address - Fax:228-872-1749
Practice Address - Street 1:4708 GIBSON RD
Practice Address - Street 2:#105
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-6042
Practice Address - Country:US
Practice Address - Phone:228-872-1749
Practice Address - Fax:228-872-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL241367133NN1002X
FL2341402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty